FEEDBACK REPORT (PRE-EVALUATION)

NAME: ___________________________________________ DEPT. ________________________

DATE ISSUED: _____________________ POSITION: ________________________
POSITIVE FEEDBACK & OBSERVATIONS
ATTITUDE
1
2
3
4
5

WORK PERFORMANCE
1
2
3
4
5
NEGATIVE FEEDBACK & OBSERVATIONS
ATTITUDE
1
2
3
4
5
WORK PERFORMANCE
1
2

RECOMMENDATION: Continuation of employment but schedule for regular Counseling or change of JD or

department.

Evaluated by: Noted by:

____________________________________ ____________________________________
Immediate Supervisor President / General Manager

Employee Signature Over Printed Name:

____________________________________
ADDENDUM TO PAR_NAME OF EMPLOYEE