PT.

SEJAHTERA SALAMINA xxxxxxxxxxxxxxx

Jl. Xxxxxxxx

PERFORMANCE EVALUATION SHEET

Employee's Data 1st Evaluator (Direct Supervisor) : Accounting Manager Grade :

Name Mr./Ms. X 2nd Evaluator (Work Colleague) : Chief of Finance 5 = Very good
Position Chief of Accounting 3rd Evaluator (Direct Subordinate) : Accounting Staff 3 = Sufficient
Department Finance, Accounting & Tax Evaluation Period : 12 months 1 = Lacking
Working Period 12 months Date of Evaluation :Dec 2012

Weight 1st Evaluator (50%) 2nd Evaluator (30%) 3rd Evaluator (20%) Final Grade :
Evaluation Criteria
G GxB G GxB G GxB Exceptional = 18< x <20
1 Work Quality 1 4 4 5 5 5 5 Excellent = 16< x <18
2 Dutifulness 1 5 5 5 5 5 5 Good = 14< x <16
3 Team work 1 5 5 5 5 5 5 Average = 12< x <14
4 Initiative 1 5 5 5 5 5 5 Insufficient = below 12
TOTAL 4 Sub Total 1 19 Sub Total 1 20 Sub Total 2 20

Attendance and Discipline (filled by HRD) Score : [Sub Total 1 x50%] + [Sub Total 2 x 30%]+[Sub Total 1 x20%]

Overdue Sick leave Permit

Score = 9.5 6 4 = 19.5

1 x ……… days 3 x .…… days 5 x .…… days Final Grade: Score -- Attandance deduction

Absence Warning letter Memoranda Exceptional 19.5

15 x ……… days (- 30)/letter (- 50)/memoranda
0 0 0
 PT. SEJAHTERA SALAMINA xxxxxxxxxxxxxxx
Jl. Xxxxxxxx

FORM PENILAIAN KINERJA TAHUNAN

Karyawan Staff

IDENTITAS PEKERJA PENILAI 1 (Atasan Langsung) : Imas Puspitasari Grade :

Nama Mr. / Ms. X PENILAI 2 (Ka.Dept.) : Devi Nugrahayu 5 = Sangat baik
Bagian Admin Tender PENILAI 3 (General Manager) : Roes Arief Budiman 4 = Baik
Dept. Marketing - Tender Admin Periode Penilaian : 1 Tahun (Jan - Des 2011) 3 = Cukup Final Grade :
Masa kerja 11 Bulan / Oct'2010 Tanggal Penilaian : Des 2011 2 = Kurang A = 421 - 500

Bobot Penilai 1 (50%) Penilai 1 (30%) Penilai 2 (20%) B = 341 - 420

KRITERIA PENILAIAN
G GxB G GxB G GxB C = 261 - 340
1 Kualitas Kerja 25 5 125 5 125 5 125 D = < 261
2 Kepatuhan 25 5 125 5 125 5 125
3 Kerjasama / Team Work 25 5 125 5 125 5 125 Ttd Penilai 1 Ttd Penilai 2
4 Inisiatif 25 5 125 3 75 3 75
JUMLAH 100 Sub Total 1 500 Sub Total 1 450 Sub Total 2 450
PENILAIAN ABSENSI & DISIPLIN (Diisi oleh HRD) Score : [Sub Total 1 x50%] + [Sub Total 2 x 30%]+[Sub Total 1 x20%]
Datang Lambat / Lupa
Sakit Ijin
Score = 250 135 90 = 475
Catat

1 x ……… hari 3 x .…… hari 5 x .…… hari Final Grade / NILAI AKHIR : Score -- Potongan Absensi Catatan :
Pekerja yang mendapat Surat

Mangkir Surat Teguran Surat Peringatan A 425 Peringatan tidak berhak mendapat Final
Grade "B"
15 x ……… hari (- 30)/kali (- 50)/kali
1x