PERFORMANCE REVIEW FORM for Supervisory Staff
Employee Name:
Job Title:
Reports to:
Number of People Supervised:
Performance Review Period:
from July 1, 2014 to June 30, 2015
Program / Department Head (if different):
Process: Employee and Supervisor each completes this form independently, then meet to review and finalize by July 15th. Program/ Department Head
and/or Executive Director must review and sign as well. The final evaluation, along with comments and signatures, is then forwarded to Human
Resources for tracking and filing in the employee’s Personnel folder.
Review of Job-specific Expectations/Standards/Competencies – based on job description
4 Exemplary
3 Proficient
2 Needs Improvement
1 Unsatisfactory
3 “Proficient” - complied with all essential duties of job; results planned were accomplished.
#
Include comments for noteworthy concerns or
accomplishments
Job Knowledge – Produces results which meet the intended objectives, demonstrates professional
competency. Keeps abreast of current developments and uses resources effectively.
Other (from job description):
Other (from job description):
Significant accomplishments/concerns
Priority goals/objectives planned for this performance review period:
Personal:
Organizational:
Outcomes
Development plans for this performance review period regarding ways employee can improve on or
learn new knowledge/skills:
Employee’s Summary Performance Statement: “How I added value to the Collaborative this year”:
Review of Agency-wide Expectations
4 Exemplary
3 Proficient
2 Needs Improvement
1 Unsatisfactory
3 “Proficient” - on target with agency expectations for the position.
#
Include comments for noteworthy concerns or
accomplishments
Developing Others - Works to improve and reinforce performance of others in a manner that builds confidence
and maintains self-esteem. Provides clear and effective feedback on a regular basis. Fosters the professional
development of staff.
Team Leadership –Willingly cooperates and works collaboratively toward solutions that generally benefit all
involved parties; works to build consensus within team/program/agency. Participates willingly in activities as a
good role player that works well with others.
Initiative – Presents suggestions constructively and demonstrates willingness to follow through to implement
them. Volunteers for special assignments. Shares experience and knowledge with others to facilitate effective
solutions to problems.
Fiscal Responsibility & Management – Strives to impact “the bottom line” by looking at ways to improve
practices /processes and savings without sacrificing quality. Maintains appropriate controls to stay within
budget.
Relationships – Treats internal and external stakeholders with courtesy, respect, dignity, fairness, and
honesty. Presents a positive public image when representing the agency.
Communication – Communicates effectively using appropriate medium, knows when and how to listen; keeps
Name /Performance Review Period:
subordinates, peers and superiors informed of decisions, changes and other relevant information in a clear and
timely manner. Recognizes conflict and identifies ways to help involved parties work through differences. Uses
creative approaches to gain support and commitment to meet program and agency goals.
Collaborative Leadership – Promotes and generates cooperation among individuals and groups to achieve a
collective outcome; fosters the development of a common vision and fully participates in creating a unified
leadership team that get results. Effective at hiring and evaluating employees, providing performance feedback
and facilitating professional growth.
Judgment – Uses logical approach in addressing problems and opportunities, drawing on his/her knowledge/
experience and reaching out for help when needed. Accepts ownership and responsibility for actions.
Support of Policies & Regulations – Understands, supports, promotes and upholds both publically and
privately, the policies of the agency. Demonstrates knowledge of Federal and State regulations / legal
requirements and acts accordingly.
Computer Skills – Has a strong knowledge and abilities with regard to computer skills. Takes the initiative to
keep current in this area.
Change Leadership –Initiates and/or manages the change process and energizes it on an ongoing basis,
taking steps to remove barriers or accelerate its pace. Serves as a personal model of the change that one
expects of others by demonstrating commitment to innovation and continuous improvement in organizational
performance.
Goals and Objectives for the next performance review period: (Specify Personal vs. Departmental/Organizational)
Employee Development Plan: Describe Job Specific, Technology and Personal Growth training the employee will focus on during the next review period.
Personal:
Organizational:
Final Evaluation Comments and Signatures
Supervisor’s Comments:
Supervisor’s Signature ____________________________________________________________________ Date: _________________
Employee’s Comments:
Employee’s Signature ____________________________________________________________________ Date: _________________
Note: this signature only indicates receipt of the review; not agreement
Program /Department Head Signature /Date __________________________________________________
Executive Director’s Signature/Date _____________________________________________________
Name /Performance Review Period:
Received by HR date: Follow up plan: