Charter Based Employee Performance Evaluation – Non-Supervisory Position

for the Performance Year 2021

Employee Name ‫ﺩﻻﻝ ﻓﻠﻴﺢ ﺍﻟﻨﺸﻤﻲ ﺍﻟﺤﺎﺯﻣﻲ‬

Department / Division Employee ID#

‫ﺍﻟﺸﺌﻮﻥ ﺍﻟﺼﺤﻴﺔ ﺑﻤﻨﻄﻘﺔ ﺍﻟﺤﺪﻭﺩ ﺍﻟﺸﻤﺎﻟﻴﺔ‬ 4506183

Manager(The Evaluator) Job Title

‫ﻋﺎﻣﺮ ﻣﺤﻤﺪ ﻓﺎﺋﺰ ﺍﻟﻌﻨﺰﻱ‬ ‫ﻓﻨﻴﺔ ﺗﻤﺮﻳﺾ ﻧﺴﺎﺀ‬

Actual employer Salary scale type

‫ ﻣﺴﺘﺸﻔﻰ ﻃﺮﻳﻒ‬-- ‫ﺍﻟﺤﺪﻭﺩ ﺍﻟﺸﻤﺎﻟﻴﺔ‬ ‫ﻛﺎﺩﺭ ﺻﺤﻲ‬

Part-1: The Goals

Evaluation Evaluation Percentage Measure Unit of

Actual output Targeted output Measurement
Result Result Value Weight Type Measure Type The Goal #
Criteria

Attend Training Courses Relevant

to Employee Work or
Specialization During the
4 4 20 20 10% ‫ﺣﺪ ﺃﺩﻧﻰ‬ ‫ﺍﻟﺮﻗﻢ‬ ‫ﺳﺎﻋﺔ‬ Performance Evaluation Cycle || 1
‫ﺣﻀﻮﺭ ﺩﻭﺭﺍﺕ ﺗﺪﺭﻳﺒﻴﺔ ﻓﻲ ﻣﺠﺎﻝ ﺗﺨﺼﺼﻪ ﺃﻭ‬
‫ﻋﻤﻠﻪ ﺧﻼﻝ ﺩﻭﺭﺓ ﺍﻷﺩﺍﺀ‬
‫ﺍﻟﻌﻤﻞ ﻋﻠﻰ ﺍﺯﺍﻟﺔ ﺍﻟﺘﻠﻮﺙ ﻣﻦ ﺍﻻﺩﻭﺍﺕ‬
5 5 200 180 25% ‫ﺣﺪ ﺃﺩﻧﻰ‬ ‫ﺍﻟﺮﻗﻢ‬ 150 2
‫ﺍﻟﺠﺮﺍﺣﻴﻪ‬
‫ﺍﺳﺘﻼﻡ ﺍﻻﺩﻭﺍﺕ ﺍﻟﺠﺮﺍﺣﻴﻪ ﻣﻦ ﺟﻤﻴﻊ ﺍﻗﺴﺎﻡ‬
5 5 230 220 25% ‫ﺣﺪ ﺃﺩﻧﻰ‬ ‫ﺍﻟﺮﻗﻢ‬ 200 3
‫ﺍﻟﻤﺴﺘﺸﻔﻰ‬
5 5 250 230 20% ‫ﺣﺪ ﺃﺩﻧﻰ‬ ‫ﺍﻟﺮﻗﻢ‬ 200 ‫ﺗﺼﻨﻴﻒ ﺍﻻﺩﻭﺍﺕ ﺍﻟﺠﺮﺍﺣﻴﻪ ﻭﺗﻌﻘﻴﻤﻬﺎ‬ 4
‫ﺗﻮﺯﻳﻊ ﺍﻻﺩﻭﺍﺕ ﺍﻟﺠﺮﺍﺣﻴﻪ ﺍﻟﻤﻌﻘﻤﻪ ﻟﺠﻤﻴﻊ‬
5 5 220 200 20% ‫ﺣﺪ ﺃﺩﻧﻰ‬ ‫ﺍﻟﺮﻗﻢ‬ 180 5
‫ﺍﻗﺴﺎﻡ ﺍﻟﻤﺴﺘﺸﻔﻰ‬

4.9 Total of Evaluation

Certified Seal
 Employee ID# 4506183 Employee Name ‫ﺩﻻﻝ ﻓﻠﻴﺢ ﺍﻟﻨﺸﻤﻲ ﺍﻟﺤﺎﺯﻣﻲ‬

Part-2: Competencies

Evaluation Evaluation Percentage

the output level required level Behavioral Description of Competencies Competencies #
Results Results value Weight

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Responsible for his decisions and duties, and not blaming others

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Understanding his role and how it's related to organizational goals 15% Responsibility 1

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Reveal transparently about challenges faced at work

Sharing information openly with others according to the work requirement

‫ﻣﻤﺘﺎﺯ‬ 5 5 4

Seeking Support from people working in other department by building good Collaboration
‫ﻣﻤﺘﺎﺯ‬ 5 5 4 relationship 20%
(Teamwork skills)
2

Respond to the request for support & assistance from employees from
‫ﻣﻤﺘﺎﺯ‬ 5 5 4 other departments

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Use clear & effective written communication

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Use clear & effective verbal communication 10% Communication 3

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Listen carefully to others

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Able to prioritize work and manage multiple tasks according to their priority

Can be relied upon & carries out all tasks in timely manner with high quality
‫ﻣﻤﺘﺎﺯ‬ 5 5 4
work
30% Achievement 4

Able to took initiatives to accomplish tasks without any guidance from

‫ﻣﻤﺘﺎﺯ‬ 5 5 4
supervisor

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Exercise self-learning & self-development

10% Development 5
‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Help others for their professional development

5
‫ﻣﻤﺘﺎﺯ‬ 5 4 Able to face challenges at work

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Seeking to reach high level of achievements and innovation during work Employee
15% 6
Commitment

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Committed to working hours and available when needed

‫ﻣﻤﺘﺎﺯ‬ 5 5 4 Focused on "Customer Service" while performing duties

5 Total Evaluation of Competencies

Certified Seal
 Charter Based Employee Performance Evaluation – Non-Supervisory Position
for the Performance Year 2021

Employee Name
‫ﺩﻻﻝ ﻓﻠﻴﺢ ﺍﻟﻨﺸﻤﻲ ﺍﻟﺤﺎﺯﻣﻲ‬

Department / Division Employee ID#

‫ﺍﻟﺸﺌﻮﻥ ﺍﻟﺼﺤﻴﺔ ﺑﻤﻨﻄﻘﺔ ﺍﻟﺤﺪﻭﺩ ﺍﻟﺸﻤﺎﻟﻴﺔ‬ 4506183

Manager(The Evaluator) Job Title

‫ﻋﺎﻣﺮ ﻣﺤﻤﺪ ﻓﺎﺋﺰ ﺍﻟﻌﻨﺰﻱ‬ ‫ﻓﻨﻴﺔ ﺗﻤﺮﻳﺾ ﻧﺴﺎﺀ‬

Actual employer Salary scale type

‫ ﻣﺴﺘﺸﻔﻰ ﻃﺮﻳﻒ‬-- ‫ﺍﻟﺤﺪﻭﺩ ﺍﻟﺸﻤﺎﻟﻴﺔ‬ ‫ﻛﺎﺩﺭ ﺻﺤﻲ‬

Performance Period Semiannual

Annually
revision

Hold Valid BLS Certificate Yes No

Final result of Employee's Performance

The employee's
management undertakes to Justifications for The result (before The result (after Final result Rank
provide supporting appreciation approximate) approximate)
documents when requested (Excellent/unsatisfactory)
for assessment
(excellent/unsatisfactory)
‫ﻧﻌﻢ‬ 4.97 5 ‫ﻣﻤﺘﺎﺯ‬ 1

Points needs improvement Strength Points

‫ﺍﻟﻘﺪﺭﻩ ﻋﻠﻰ ﺗﺤﻤﻞ ﺿﻐﻂ ﺍﻟﻌﻤﻞ‬

‫ﻻ ﻳﻮﺟﺪ‬ ‫ﺍﻟﻘﺪﺭﻩ ﻋﻠﻰ ﺣﻞ ﺍﻟﻤﺸﺎﻛﻞ‬
‫ﺍﻟﻘﺪﺭﻩ ﻋﻠﻰ ﺍﻟﺘﻮﺍﺻﻞ ﺍﻟﺴﺮﻳﻊ‬

Seal of the General Department of HRP and OD (Job Performance Management) Date

2021/12/19 11:38:42