STAFF PERFORMANCE APPRAISAL FORM

NATIONAL INSTITUTE FOR MEDICAL RESEARCH

OPEN PERFORMANCE REVIEW AND APPRAISAL FORM
(To be filled in Triplicate)

From JULY 2023 to SEPTEMBER 2023

This Form shall be used for appraisal to all staff of NIMR. It is intended to meet the requirements
of the performance management system and development process.

NOTES ON HOW TO FILL THIS FORM

1. This form must be filled by all NIMR staff with his/her Supervisor in an interactive open exchange . For all
officers, at the end of the year/Contract, once fully completed, the original should be sent to the Director General,
duplicate to the respective Head of Directorate/Center Director to be placed in the personal file and triplicate to the
Appraisee. The Director of Finance, Human Resources and Planning shall be the coordinator in processing this
exercise.

2. Where appropriate, each box shall carry only one letter or figure. Letters to be in capitals.
3. Agreed objectives are derived from the NIMR workplan (Strategic plan, Annual operating plans or Action plans
and other NIMR directives e. g. Scheme of Service, Staff Regulations etc.) are expected to be implemented in the
current year.
4. Sections 2 and 3 of this Form shall be filled by the Appraisee in consultation with the Supervisor and Section 4 –
5 in the presence of a third party if any.
5. Where ratings of both the Appraisee and the Supervisor are the same, the agreed rating shall be registered in
the appropriate column . In case of any disagreements the ratings of both Appraisee and Supervisor shall also be
registered in the appropriate columns and commended on in Section 6
6. Please note that appraisals that are rated as 1 are the best performers and those rated as 5 are the worst performers.
These should be brought to the attention of top management and usually to the attention of the Director General.
7. After every annual review, the dully filled appraisal form should reach the HR Office by 1 st December and NIMR
HQ by15th December or any appropriate time
8. Where applicable, appraisee should attach a full list of publications since last promotion/Contract engagement.
Copies of relevant certificates attained during the period must also be attached.
9. Employees will be served with appraisal notice .which shall be not less than 7 days, specifying time and location

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 SECTION 1: PERSONAL INFORMATION

File Number NIMR/MWZ/CPF/GE/2

Present Centre/Station
NIMR, Mwanza Centre

Name in Full GEORGE ATHANAS Gender

BENEDICT M

Surname First name Middle name

Highest Academic Qualification

BSC BIOLOGY
Current Post Substantive Post
RESEARCH ASSISTANT

Date of First Appointment Date of Appointment to present post

06/07/2023
D D M M Y Y Y Y D D M M Y Y Y Y

Salary Scale Period served under

Present supervisor
03 Date of Birth 28 0 6 1 9 9 6
Terms of service SHORT TERM CONTRACT No. of Months 4666666666666666
66666666666666
DDMM
Y Y Y Y
666

DD = Day, MM = Month, YYYY = Year, F = Female, M = Male

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 SECTION 2: PERFORMANCE AGREEMENT ( )
To be filled by Appraisee in Consultation with the Supervisor

Activity Agreed Performance Agreed Performance Weight (%)

Agreed Objectives
Data collection To understand the current
situation about transactional sex
Translation of To make the study materials
study materials more understandable to RA and
respondents
Report writing To understand the achievement
and the challenge from the field
Performing other To do any other work assigned
related duties by Research manager
Targets Indicator
To collect quality data RA must go to the field
and collect a minimum to collect data
number of three
surveys per day
At least all the study Every RA must
materials were put in participate in translation
Swahili language of study materials
At least one report per At least one report was
day written per day
Any other related task All other related task
has to be performed assigned by Research
manager was done

Appraisee

ATHANAS BENEDICT GEORGE 10/10/2023

Name Signature Date

Supervisor
____________________________ _________________ ___________________
Name Signature Date

Observer (Optional)

____________________________ _________________ ___________________

Name Signature Date

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SECTION 3: QUARTERLY REVIEW ( JULY to September 2023)

3.1 To be filled by the Appraisee in Consultation with the Supervisor

SECTION 3.1 (a) PERFORMANCE REVIEW

Activity Progress towards target Factor influencing performance

Agreed Objectives
Data collection To understand the current situation The crossectional survey The team worked hard even
about transactional sex was completed weekend days so as to finish up the
work
Translation of the To make the study materials more The study materials The team cooperated to translate
study materials understandable to RA and respondents were all translated and the study materials
installed in Tablets
Report writing To understand the achievements and All the field reports RA sent data on time and then the
challenges from the field were written and sent to data were sent to supervisor
the Research manager
and principal
investigator
Performing any To do any other work assigned by the All other related works All the assigned works were all
other related duties Research manager assigned by the done on time
supervisor were all
accomplished

SECTION 3.1 (b). REVISED OBJECTIVES (if any)

Agreed Revised Agreed Performance Agreed Performance Weight (%)
Objective(s) Targets Indicator

NON NON NON NA

Appraisee

__________________________ __________________ ___________________

Name Signature Date

Supervisor

____________________________ _________________ ___________________

Name Signature Date

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 SECTION 4: ANNUAL /END OF CONTRACT PERFOMANCE REVIEW & APPRAISAL ( )

(To be filled by the Appraisee and the supervisor)

Activity Progress towards Rated Mark Final

Agreed Objectives target agreed
rate
Data collection To understand the Crossectional Appraissee Supervisor
current situation survey was 1
about transactional successfully
sex completed
Translation of the To make the study All the study 2
study materials materials more materials were
understandable to translated and
RA and respondents installed in the RA
tablets
Report writing To understand the Dairy field work 1
achievements and reports were
challenges from the written and sent to
field Research manager
Performing other To do any other All other work 1
related duties work assigned by assigned by the
the supervisor supervisor were all
accomplished

Rating:
1 = outstanding performance 2 = performance above average 3 = Average performance
4 = Poor performance 5 = Very poor performance

NOTE : 1= ≥90% ; 2 = 76-89 ; 3=51-75; 4 =31-50; 5≤30

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 SECTION 5: ATTRIBUTE OF GOOD PERFORMANCE
(To be filled by the Appraisee and the supervisor)

S/ QULITY ATTRIBUTE
Rated Mark
N MAIN FACTORS Final Agreed
Appraissee Supervisor rating
WORKING Ability to work in a team 1
RELATIONSHIP
Ability to get on with other 2
staff

Ability to gain respect from 1

others

Ability to express in writing 2

COMMUNICATION
AND LISTENING Ability to express orally 1

Ability to train and develop 2

subordinates
Ability to plan and organize 2
MANAGEMENT AND
LEADERSHIP Ability to lead, motivate and 2
resolve conflicts
Ability to initiate and innovate 2

PERFORMANCE IN Ability to deliver accurate and 1

TERMS OF QUALITY high quality output timely
Ability for resilience and 1
persistence
PERFORMANCE IN Ability to meet demand 1
TERMS OF QUANTITY
Ability to handle extra work 1
RESPONSIBILITY AND Ability to accept and fulfill 1
JUDGEMENT responsibility
2
Ability to make right decisions
CUSTOMER FOCUS Ability to respond well to the 1
customer
Ability to demonstrate 2
LOYALTY fellowship skills
Ability to provide ongoing 2
support to supervisor (s)
Ability to comply with lawful 1
instructions of supervisor
Ability to devote working time 1
INTEGRITY exclusively to work related
duties
Ability to provide quality 1
services without need for any
inducements

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 Ability to apply knowledge 1
abilities to benefit NIMR and
not for personal gains
Overall Performance 2
Section 5
Rating as per Section 4

SECTION 6: OVERALL PERFORMANCE (AVARAGE OF SECTIONS 4 & 5)

Apraisee Supervisor Final Agreed

rating
2
COMMENTS BY APPRAISEE (if any)
__________________________________________________________________________
__________________________________________________________________________

_________________ ____________________
SECTION 7: REWARDS/SANCTIONS
Date Signature of Appraisee
Supervisors and subordinates should agree on what the most appropriate reward or sanction
should be. These should be as creative as possible, especially considering all possible non-
financial awards that fit the performance achieved

SECTION 8: COMMENTS BY REPORTING OFFICER ON STAFF ADVANCEMENT

COMMENTS BY SUPERVISOR (if any):
i. Deserves confirmation ( )
ii. This officer deserves promotion ( )
iii. This officer deserves normal increment ( )
iv. This officer deserves accelerated increment ( )
v. This officer deserves stoppage of increment ( )
vi. _______________
This officer deserves a warning ______________ ______________
( )
vii. This officer deserves termination of service ( )
Name of Supervisor Signature Date
COMMENTS BY OBSERVER (if any)
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________

___________________ _______________ _______________

Name of Observer Signature Date

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SECTION 8: COMMENTS BY REPORTING OFFICER/SUPERVISOR ON STAFF ADVANCEMENT

i. Deserves Contract extension/renewal ( )

ii. Does NOT qualify for contract extension ( )

iii. This officer deserves termination of service ( )

SECTION 9: CERTIFICATE OF THE REPORTING OFFICER

I certify to the best of my knowledge that, work performance and efficiency of the officer rated above is correct.
Also this report has been discussed and agreed upon with the officer in accordance with the INSTITUTE’S POLICY
of assessment.

……………………. ……………………….. …………………….

Date Designation Signature

SECTION 10: COMMENTS ON REPORTING OFFICER’S REPORT (If the Supervisor was not the Head of
department)

……………………. ……………………….. …………………….

Date Designation Signature

SECTION 11: CENTRE HUMAN RESOURCE OFFICER’S REMARKS

______________________________________________________________________

……………………. ……………………….. …………………….

Date Designation Signature

SECTION 12: CENTRE DIRECTOR’S REMARKS

______________________________________________________________________

……………………. ……………………….. …………………….

Date Designation Signature