David Geffen School of Medicine at UCLA
Dean’s Office
INSTRUCTIONS FOR COMPLETING STAFF PERFORMANCE APPRAISAL
A principle means of establishing the commitment and enthusiasm to achieve excellence is to
acknowledge the responsibility for self-management within each person. Most employees have
strong expectations about their own performance, want to do a good job and want to grow and
develop professionally.
This is a “joint” performance evaluation system to be completed by BOTH the employee and
supervisor. The evaluation of performance is initiated by each employee and then discussed with
the supervisor (who also prepares an evaluation). The evaluation process is designed to facilitate
open communication between the employee and supervisor regarding performance expectations
and outcomes. The emphasis is on self-assessment, skill development and improvement.
By working together to review performance, employees and supervisors can bring about greater
job satisfaction contributing to improved service and organizational effectiveness.
Guidelines for the Employee
The Staff Performance Appraisal form is on an electronic template. Each section expands to
accommodate the amount of response text entered. You may write as much or as little as you
wish.
1.
Complete the PRIMARY RESPONSIBILITIES section. Think about the
responsibilities you have that are critical to the successful performance of your job.
Avoid simply listing individual job tasks.
2.
For the ACCOMPLISHMENTS SECTION, review your last Development Plan if you
did one, and list those accomplishments specifically related to that plan. Then, list all
accomplishments during the rating period. Accomplishments can include:
improvements made in performance, goals achieved, special projects to which you
contributed, education completed, certificates or licenses earned, and new skills acquired.
3.
Complete the PERFORMANCE CATEGORIES section using the rating scale
provided. You may use a plus (+) or minus (-) sign to indicate performance that is in
between ratings. Summarize your performance with an “Overall Rating”.
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4.
Review your last DEVELOPMENT PLAN. Did you accomplish goals set? If not,
consider the reasons you did not. Be prepared to discuss with your supervisor at your
review meeting what you did and did not accomplish, as well as ideas for future
development activities.
5.
Schedule a one hour meeting with your supervisor and discuss your performance using
the form as your guideline. Jointly review your comments and ratings as well as your
supervisor’s. Discuss and, if possible, resolve differences.
6.
The EMPLOYEE COMMENTS section of the form is provided for your comments,
either before or after you have discussed the evaluation with your supervisor.
PROCESSING INSTRUCTIONS
Sections I and II to be completed by the Employee.
Section III to be completed independently by the Employee and Supervisor.
Sections IV and V to be completed by the Supervisor.
Sections V and VII to be completed jointly by the Employee and Supervisor.
Section VII to be completed by the Employee.

A Note on Supervisory Employees:
There are two templates: one for non-supervisory employees and one for those with
supervisory/managerial responsibilities.
Definition: A supervisory employee is one who supervises MORE THAN ONE (1) career
or casual, non-student AND performs at least three (3) of the following functions:
- hiring
- performance evaluation
- work assignment/work review
- pay decisions/recommendations re: merit increases, reclassifications, etc.
- corrective action/termination
- complaint/grievance resolution
Employees who supervise only one (1) non-student employee, who supervise any number of
non-student employees but are responsible for less than three of the above functions, or who
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supervise only students do not meet the definition of supervisors under California law and,
instead, are considered to be “LEAD” employees. Lead employees are to be evaluated in section
III.(A).
To the Employee:
You will receive the Staff Performance Appraisal Form via e-mail by your supervisor.
1.
Complete Sections I and II by typing in responses. Complete Section III by typing
responses in the “Self Comments” section. Electronically FORWARD the Performance
Appraisal to your Supervisor as an e-mail “attachment”.
To the Supervisor:
2.
Complete Section III, “Supervisor’s Comments”, Section IV, (Including Overall
Evaluation), and Section V.* FORWARD back to the Employee with a date set for a
“one on one” meeting to discuss this evaluation and proposed salary
recommendation. At this meeting, differences in ratings should be discussed in depth.
Changes in the evaluation and/or salary recommendation can be made at this time, with
the goal of reaching a mutually acceptable assessment of performance, including
accomplishments and areas where improvement may be needed.
3.
Complete Section VI and optionally Section VII, jointly with Employee.
4.
Make any agreed upon changes to previously completed sections directly on the template
and FORWARD back to Employee.
To the Employee:
5.
Review final evaluation, optionally complete Section VIII, and FORWARD back to the
Supervisor.
To the Supervisor:
6.
PRINT and SIGN final Performance Appraisal. Obtain Employee signature. Also
have the Reviewing Manager review and sign.. Give original to Employee, send copy to
Personnel File.
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