Performance Evaluation Form (exempt employees)

Dept / Division
Period Covered: 09/01/2014 - PRESENT
The purpose of this performance evaluation is to serve as a format for discussing the employee’s
past performance, the strengths and opportunities for improvement in order to assist the
employee in improving his/her performance, and to set goals for the upcoming performance
period. This is also a tool for the employee to inform the supervisor of his/her needs for personal
Note: Supervisor will distribute Part III. Employee Input document to employee being evaluated.
Performance Standards
Exceeds Expectations: Performance is consistently and significantly above job expectations and
requirements. Demonstrates the willingness to assume additional responsibilities.
Meets Expectations: Performance regularly accomplishes what is expected. Performance
demonstrates the required skills and knowledge for the position and sometimes exceeds
Needs Attention: Performance meets only the minimum requirements, which could be improved
through development, experience, and/or application. Performance is below accepted levels for
the time in the position, and needs improvement.
No Basis or N/A: Opportunity to observe employee’s ability to meet standard not sufficiently
observed during review period or described criteria does not apply to employee’s position.
Part I: Supervisor Ratings and Comments
In this Part, review the employee’s performance. Consider time in this job when assessing the
employee’s performance. Note that there are four levels in which to rate performance. For
details on the various levels, refer to the Performance Standards and Guidelines. Write specific
examples or comments supporting each rating.
Effectiveness - Carries out work assignments and tasks while meeting time, budget, and quality
commitments with little or no supervision. Completes high-quality work according to plans and
expectations. Has demonstrated the ability to improve procedures and processes.
Exceeds Expectations
Meets Expectations
Needs Attention
No Basis or N/A
Leadership – Gains support and cooperation of work group and others. Utilizes employees’
abilities effectively to achieve results.
Exceeds Expectations
Meets Expectations
Needs Attention
No Basis or N/A
Initiative - Willingness to make significant contributions with little direction, voluntarily starts
projects, and attempts non-routine jobs and tasks. The employee is self-starting and proactive.
Exceeds Expectations
Meets Expectations
Needs Attention
No Basis or N/A
Teamwork/Communication - Facilitates a positive and productive team-oriented work
environment and encourages open communications throughout the organization.
Exceeds Expectations
Meets Expectations
Needs Attention
No Basis or N/A
Overall Rating – Taking into consideration all of the above ratings and the significance of those
items as they relate to the employee’s overall performance, provide the employee with an overall
rating for the year.
Exceeds Expectations
Meets Expectations
Needs Attention
No Basis or N/A
Section II. Goals and Expectations for Upcoming Year
As part of the performance appraisal, discuss and establish expectations that support your
department’s goals and objectives and, as applicable, the organization’s strategic plan for the
ensuing rating period. Expectations for specific projects and initiatives as well as planned
personal development and any other goals and expectations for this particular role should be
identified, and target dates established for attainment or completion identified where possible.
Specific Projects and Initiatives:
Other Goals and Expectations:
Professional Development:
Discussion of Review with Employee and Signatures
The contents of this form have been reviewed with me and my comments are included below:
Employee’s Signature: _________________________________ Date: ____/_____/2015
**I also acknowledge I have attached the Employee Input Form (Section III)
Reviewer’s Signature: _________________________________
For HR Use Only: Evaluation Received:
Original to Human Resources
Copy to Employee
Date: ____/_____/2015
Banner ID: 800____________
Period Covered: 09/01/2013 - PRESENT
Part III. Exempt Employee Input Form
This part of the evaluation provides an opportunity for the employee to present information to
their supervisor. The supervisor will distribute this part to the employee and the employee will
return the completed Part III prior to the review meeting and attach it to the review.
A. Professional Development and Contribution to One’s Profession To maintain
maximum effectiveness, employees should continuously supplement and update their
professional knowledge and skills. Please describe your career development activities and
plans, and your contribution to your profession:
B. Departmental Goals What do you see as your departmental goals for the next year?
Employee’s Signature