Executive Performance and Development Assessment 2014-15
Name:
Department:
Signature:
*Supervisor Endorsement:
*Recommended:
Approval:
Approved / Not Approved
[Insert name]
[Insert title]
Date:
[Supervisor name]
[Position]
Date:
[Supervisor name]
[Position]
Date:
[Chief Executive]
Date:
Comments:
Comments:
Comments:
Comments:
*Supervisors are asked to comment on how well the executive has met their expectations and the executive’s overall level of performance.
Part 1: Performance Self-Assessment
Performance
Objectives
Intended Outcomes
(Information included in this table to be provided by the Executive)
Evidence that the objective has been achieved
Self Assessment
Rating 1 to 5
Summary of achievements
(Includes any issues in Mid-year check)
Financial Perspective

Services delivered within
overall budget
appropriation, including
operating expenses,
revenue and capital
outlays
1.
Fiscally
responsible
service delivery  Value for money
achieved through
renewal of service
delivery
Stakeholder and Outcome Perspective
2.
Renewed
services
delivering
better
outcomes for
customers and
stakeholders
Rating Scale:

Services renewed and
re-prioritised to better
meet customer and
stakeholder needs
 Innovative service
delivery models
implemented through
cross agency and cross
sector collaboration and
customer feedback
5 - Far exceeds expectations
4 - Exceeds expectations 3 - Meets expectations
2 - Partially meets expectations
1 - Requires development
Performance
Objectives
Intended Outcomes
Evidence that the objective has been achieved
Self
Assessment
Rating 1 to 5
Summary of achievements
(Includes any issues in Mid-year Check)
Internal Business Perspective

Strategies, plans,
3.
policies, systems and
Internal
processes aligned to
renewal agenda
business
operations
 Internal business
renewed for
operations streamlined
to support a high
improved
performing
service delivery
organisation
Learning and Growth Perspective
4.
High
performing,
customerfocussed
workforce

Workplace culture and
values aligned to
deliver government
renewal agenda

Highly capable and
high performing
leaders
 Highly engaged and
capable workforce
Rating Scale:
5 - Far exceeds expectations
4 - Exceeds expectations 3 - Meets expectations
2 - Partially meets expectations
1 - Requires development
Part 2: Personal Statements by Executive and Supervisor
These statements should explain how the executive achieved their objectives. Executive statements should be no more than two pages and cover each of the four
performance perspectives.
Personal Statement by Executive
Supervisor’s Comments
Part 3: Performance Assessment
This section is completed by the Supervisor/s, for consideration by the chief executive
Performance Objectives
Balanced
Scorecard
Perspective
Performance Objectives
Assessment
Assessment Summary
(Rationale for performance assessment rating)
Rating
(1-5)
Weighting
%
Performance Score
(rating x weighting)
10%
/50
Financial
Perspective
1. Fiscally responsible service
delivery
Stakeholder
& Outcome
Perspective
2. Renewed services
delivering better outcomes
for customers and
stakeholders
40%
/200
Internal
Business
Perspective
Learning
and Growth
Perspective
3. Internal business
operations renewed for
improved service delivery
25%
/125
4. High performing
customer-focussed
workforce
25%
/125
Performance Score
/500
Part 4: End-of-year Development Assessment (July 2015)
The officer completes a traffic light self- assessment and summary of their development achievements; the supervisor completes a traffic light
assessment and comments section.
Development Priorities
End of Year Development Assessment
Development Objectives for 2014-15
Assessment
(from Agreement)
(traffic light)
Vision #
Officer’s summary of development achievements / Supervisor’s comments
Officer:
Supervisor:
Results #
Officer:
Supervisor:
Accountability #
Officer:
Supervisor:
Other
Officer:
Supervisor:
Traffic light development check:
Strong development progress being made (green) 
Development ongoing (amber) 
Requires additional support (red) 