Certificate of Completion
Town of Halifax
Performance Evaluation System
For Wage and Personnel By-Law Employees
Department/Board:
Name of Employee:
To be completed by the Employee:
I certify that my Supervisor completed my Annual Performance Evaluation and I am eligible for a step
increase according to the provisions of the Wage and Personnel By-law.
Name of Employee:
Signature of Employee
To be completed by the Supervisor:
I certify that I have completed the Annual Performance Evaluation for the employee named above and
she/he is eligible for a step increase according to the provisions of the Wage and Personnel By-law.
Name of Supervisor:
Signature of Supervisor:
Date:
OVERALL RATING: ___________________________________________________
Is Employee at their top Step:
YES
NO
Wage and Personnel:
Date:
1 Copy of Certificate of Completion to Wage and Personnel
1 Copy of Entire Evaluation to Personnel File (Assistant Treasurer)
Original – Retained by Department Head
Employee Evaluation Form Revised 10/12
Page 1
Town of Halifax
Performance Evaluation Form
Name:
Date:
Position:
Years on the Job:
Performance Relative to Position Requirement
Supervisors should document up to four key responsibilities of the position directly related to
the tasks listed on the position Description. These responsibilities should be listed from highest to
lowest in priority. Rate the performance of employee in relation to each task.
Rating
Description
CE
Consistently exceeds – Performance consistently exceed ALL Position
requirements
E
Exceeds- Performance meets and exceeds some position requirements
M
Meets- Performance consistently MEETS ALL position requirements
PM
Partially Meets – Performance meets some but not all position requirements
FTM
Fails to Meet – Performance fails to meet position requirements
N/A
Not Applicable
Employee Evaluation Form Revised 10/12
Page 2
Town of Halifax - Performance Evaluation Form
Name:
Position:
Date:
Years on the Job:
Task
Rating:
Discussion of Rating:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Task:
Rating:
Discussion of Rating
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Task:
Rating:
Discussion of Rating:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Task:
Rating:
Discussion of Rating:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Employee Evaluation Form Revised 10/12
Page 3
Town of Halifax
Performance Evaluation Form
LEADERSHIP
RATING
A) Influences others, is logical, forceful and persuasive
B) Trains, evaluates and counsels subordinates
C) Delegates responsibility
D) Manages conflict
JUDGEMENT/DECISION MAKING
RATING
A) Identifies important issues, analyses information and formulates alternative
solutions
B) Makes decisions consistent with the Towns’ economic, social and political
climate
C) Takes calculated risks based on sound decision-making
D) Makes decisions promptly
QUALITY OF WORK
RATING
A) Plans and organizes work utilizing Town resources
B) Coordinates work with others when position responsibilities and objectives
influences Work of others
C) Follows through on details of projects
D)Maintains expertise in particular field by keeping current on recent
developments
Employee Evaluation Form Revised 10/12
Page 4
COMMUNICATION AND RELATIONSHIPS
RATING
A) Effectively communicates ideas, obtains acceptance and action
B) Has mutually supportive relationships with peers
C) Is firm and fair in dealing with subordinates
D) Adjusts to differing personalities and situations
KNOWLEDGE AND SKILL
RATING
A) Progress at a pace consistent with time on the job
B) Has skills necessary for accomplishing tasks
C) Has knowledge of department goals
D) Has knowledge of policies and procedures
QUANTITY AND QUALITY OF WORK
RATING
A) Achieves production levels required
B) Maintains work standards for accuracy, neatness, etc
C) Follows through on completing tasks
D) Works productively with little supervision
INITIATIVE AND DRIVE
RATING
A) Maintains interest in work
B) Offers suggestions improving the processing of work
C) Seeks to learn new tasks and responsibilities
D) Has necessary energy level
Employee Evaluation Form Revised 10/12
Page 5
COOPERATION AND ADAPTABILITY
RATING
A) Has positive “can-do” attitude
B) Works well with others to accomplish tasks
C) Adapts easily to new systems and procedures
D) Works effectively under pressure or unusual conditions
Employee Goals and Objectives:
The specific goals and objectives that I expect the employee to achieve during the next appraisal
period are as follows:
Other/Negotiated during the Review:
Employee Comments on Complete Performance Evaluation:
Signatures:
Incumbent
Date:
Supervisor:
Date:
Employee Evaluation Form Revised 10/12
Page 6