THE TWELVE INC.
PERFORMANCE MANAGEMENT OUTLINE
for the Development and Evaluation of Managers and Supervisors
The Twelve Inc. is a leading agency in the provision of Child Welfare and Mental Health Services. The Twelve
Inc. achieves its goals through the performance and excellence of each individual. The Twelve expects all of its
employees to exemplify its values through commitment to service and concern for human relationships. As an
organization, we value:
A working environment that encourages:
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Mutual respect and open communication
Innovation and continuous learning
A cooperative spirit and teamwork
Respect for diversity and inclusiveness
Personal growth and celebration of accomplishments
Safety orientation
Personal responsibility based on:
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A customer-focused service orientation which exhibits:
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Integrity and ethics
Accountability for results
Clear goals and empowerment
Dependability
Protecting resources against waste, loss, or misuse
Employee Name
Job Title
Location
Evaluator
For the Period:
Through
Concern for the customer’s goals and needs
Economy, efficiency, and flexibility
Courtesy
Responsiveness with good judgment
Continuous and measurable improvements
SECTION I
Responsibilities/Objectives and Performance Standards in Support of Agency Goals “Maximizing
one’s professional qualifications to make a difference”
Primary Performance Expectations:
Agreed Upon Objectives
Mid-Year
Progress Notes
Objectives for new period reviewed and agreed to:
Mid-Year Review:
Annual Rating
Place X on Scale
Objective 1:
Objective 2:
Objective 3:
Objective 4:
Objective 5:
Evaluator
Date
Date Employee
Evaluator
Date
Employee
Date
SECTION II
Performance Competencies Necessary to Manage and Supervise Within a Vision
Mid-Year Progress Notes
End of Period Rating of Key
Competencies. Place an X on Scale
to rate
Not Strong
Very Strong
Establishing Direction and Focus: Develops, explains and discusses objectives
that support Program and Agency Mission.
Empowering Others: Develops employee confidence in their ability to be
successful by sharing information and allowing employees freedom to make
decisions on how objectives will be achieved and issues resolved.
Managing Performance: Provides employees with clear expectations regarding
organizational values and desired results, clear and honest performance feedback,
suggestions for training and self development and timely evaluations.
Attention to Communication: Ensures clear, timely communications to others
(both oral and written) particularly those who will be affected by change. Listens
to others carefully and attentively. Builds effective formal and informal
communication channels.
Managing Change: Initiates actions that foster acceptance of organizational
change and that build commitment to the Program and the Agency.
Service Orientation: Demonstrates concern for understanding and satisfying
needs of “customers”, co-workers and others with economy, efficiency,
flexibility, courtesy, good judgment and continuous measurable improvements.
Regularly seeks feedback on quality of and ways to improve services.
Managing the Environment: Maintains a work environment that is marked by
respect for others; that values inclusiveness and builds workforce diversity; and
that fosters cooperation and teamwork.
Safety Orientation: Observes safety standards in the workplace. Monitors,
reports and participates in resolving potential safety and security issues.
Demonstrates Initiative and Dependability: Identifies and initiates actions
independently to support the vision, mission and objectives of the Agency.
Demonstrates problem solving ability. Seeks to learn and continuously develop
self. Maintains high credibility to accomplish objectives. Uses resources wisely
and effectively.
Competencies Reviewed and Discussed
Evaluator
Date
Employee
Mid-Year Review
Date
Evaluator
Date
Employee
Date
SECTION III
A.
Additional Issues
Recommended Training Topics
1.
2.
3.
4.
5.
B.
Are you aware, in the course of your employment, of a violation by the Agency or by any fellow employee , of any state or
federal statute or any ordinance or regulation of a political subdivision that we, as your employer, would have the authority to
correct, and that you reasonably believe to be a criminal offense that is likely to cause an imminent risk of physical harm to
persons or a hazard to public health or safety , a felony, or an improper solicitation for a contribution?
________ YES
________ NO
If YES, please explain
SECTION IV
End of Period Summary Performance Rating
Based on a review of Section I, Success and Effectiveness in Position Responsibilities/Accomplishing Objectives and Standards, and
Section II, Performance Competencies, provide a summary performance rating:
Comments:
Performance consistently and significantly above standards in virtually all areas; far exceeds normal
expectations.
Performance well above standards in many important aspects; usually exceeds normal expectations.
Performance meets standards in all important aspects; good contributor.
Performance slightly below standards in some important aspects, but meets standards in others;
performance generally acceptable but improvement needed to fully achieve functional performance level.
Performance below standards in a number of critical aspects; substantial improvement needed.
Evaluator Signature ___________________________________ Date:
I have read this appraisal and it has been discussed with me. I understand that signing this appraisal does not necessarily mean I agree
with all of the information in it or that I forfeit my right for review.
Employee Signature ___________________________________
Date:
THE TWELVE INC.
Performance Management Salary Review
SECTION V
SALARY REVIEW
This form is to be used with a completed Performance Management Review for the evaluation period indicated below and should be
forwarded to the Human Resources Department for processing. This form, the completed Performance Management Review and
the Self Evaluation must be received before entry of payroll changes can be completed.
Employee Name:
Department
Job Title:
The Twelve of Ohio, Inc.
Evaluation Period:
To
Performance is consistently and significantly above standards in virtually all areas; far exceeds normal expectations
Performance is well above standards in many important aspects; usually exceeds normal expectations
Performance meets standards in all-important aspects; good contributor
Performance is slightly below standards in some important aspects, but meets standards in others; performance generally
acceptable but improvement needed to fully achieve functional performance level
Performance is below standards in a number of critical aspects; substantial improvement needed.
Current Salary: $
Salary Change Recommended: $ ____________________________
Percentage:
Effective Date:
New Salary: $
Employee Signature __________________________________________ Date
Evaluator Signature __________________________________________ Date
THE TWELVE INC.
SELF EVALUATION FORM
Name:
Program
Position:
Region:
Supervisor:
Position:
Date:
Mid-Year Evaluation
End-of-Year Evaluation
SECTION I: INSTRUCTIONS
This form is to be completed on a semi-annual basis by all employees. Please be as objective and candid as
possible in assessing your personal job performance. Complete and forward to your immediate supervisor no
later than
.
Mid-Year Self-Evaluation
 Complete self-evaluation form and return to your supervisor.
 Your supervisor will schedule a meeting with you to discuss your evaluation.
 During the meeting the following items will be discussed:
 Your self-evaluation.
 Your supervisor's assessment of your performance relative to the performance accountabilities and
objectives you have previously set together
 Ways in which your supervisor can assist you in achieving, maintaining, or
exceeding standards.
 Any necessary modifications to previously established accountabilities, objectives,
or improvement / development plans.
End-of-Year Review
 Complete self-evaluation form and return to your supervisor.
 Your supervisor will complete an annual performance appraisal. He/she will consider input from selfevaluations, as well as customer / co-worker feedback and direct performance observations and
measurements when assessing your performance relative to the accountabilities and objectives you have
previously set together.
 He/she will schedule a meeting with you to discuss this appraisal.
 Prior to the meeting:
 You will be provided with a copy of the written appraisal.
 During the meeting:
 Discussion will center on the same topics as noted above.
 Your supervisor will discuss any salary action that might result from the performance appraisal.
SECTION II: ACCOUNTABILITIES and OBJECTIVES
Provide information regarding the progress you have made toward established accountabilities and objectives.
Accountability / Objective
1.
Progress/Results:
Accountability / Objective
2.
Progress/Results:
Accountability / Objective
3.
Progress/Results:
Accountability / Objective
4.
Progress/Results:
SECTION III: MAJOR ACCOMPLISHMENTS
List what you consider to be your major accomplishments and contributions to the organization during the past
performance period (6 months for mid-year evaluation; 12 months for end-of-year evaluation).
Contributions/Accomplishments:
SECTION IV:
IMPROVEMENT / DEVELOPMENT OBJECTIVES
List the skills and/or areas of job knowledge on which you feel you should focus improvement and/or development
efforts for the upcoming year. Please note any specific actions you feel you can take to develop these skills.
Improvement/Development Areas
Steps
1
1
2
2
3
3
4
4
SECTION V: SUPERVISOR ASSISTANCE
What can your supervisor do to assist you in your daily responsibilities and to help you achieve your
development objectives?
SECTION VI:
NEW ACCOUNTABILITIES / OBJECTIVES
List any accountabilities/objectives that have become part of your overall job responsibilities since your last
review.
Accountabilities / Objectives:
1
2
SECTION VII:
PROCESS IMPROVEMENTS
Indicate suggestions for process improvements that would make your job and/or work in your department more
efficient and effective.
Suggestions:
Please feel free to attach additional sheets, if necessary.
Employee Signature
Date
THE TWELVE INC.
MULTI SOURCE FEEDBACK FORM
NOTE: This form is intended as information only. As such, it is for internal use only and is not to be mailed
or presented to customers / co-workers in any way.
Employee _______________________________________ Position ______________________
Supervisor ______________________________________ Date _________________________
Feedback
Requested From _____________________________________________
_____ Co-Worker
_____ Referral Agency Representative
Position ___________________________ Telephone _______________________
Supervisor _________________________________________
I would like to ask you for some candid feedback on _________________________ performance during this past
year. My questions are relatively brief and it should only take a few minutes.
I'm asking for your input so that I can develop a more well-rounded assessment of this employee's performance.
I will be asking several individuals (peers, customers, and/or managers) for their input and then incorporating the
overall results into the employee's annual performance review. Please be as candid and objective as possible.
Individual results will be kept completely anonymous and will only be included in the review in summary
fashion.
1. Overall Satisfaction
What is your overall level of satisfaction with his/her ability to meet your needs? Please provide specific
examples?
2. Special Projects / Contributions
In addition to his/her usual responsibilities in the past year, what special project(s) has
he/she worked on that you are aware of that have required considerable additional effort? What specific
contribution(s) did this employee make to the project's success?
3. Performance/Service Enhancements
What specific services, support, reports, projects, etc. would you like to receive from or
work on with this employee and/or department during the next year? What skills or
knowledge, if improved or developed, would help this employee become more effective in meeting your needs or
in his/her general interactions with you?
THANK YOU FOR TAKING THE TIME TO ANSWER MY QUESTIONS. THIS WILL HELP TO
PROVIDE A MORE WELL ROUNDED EVALUATION OF __________________.
NOTE: This information is to remain confidential and should only be included in
the review in summary fashion. Specific comments or assessments made by this respondent should not be
shared directly with the employee.
This form is to be kept in the Supervisor’s file only.