APPRAISAL FORM

NAME VESSEL
RANK SERVICE FM TO
AGE REASON FOR SIGN-OFF
LICENSES
This form to completed when Officer / Rating signs off and when Master or dept. head signs off

REFERENCE 1 2 3 4 5 ASSESS
1 Has shown Has shown
Has shown very high Lacks ability but Has little or no
acceptable ability satisfactory ability in
ABILITY. ability in all aspects willing to learn and ability and has not
in all aspects of his most aspects of his
of his work. has improved. improved.
work. work.
2 Conducts has been
Repeatedly guilty of Has been guilty of
exemplary. Has been Has given no cause Occasionally guilty of
CONDUCT minor offence. A bad serious misconduct
an influence for for complaint minor offences
influence and logged
good.
3 Has never been Has occasionally Does not mix with Quarrelsome and a
Frequently quarrels
COMPATIBILITY known to quarrel had minor quarrels others but causes no disruptive
with other
with anyone with others trouble influence.
4 Has been extremely Works well at times Has had to be
Has always been a Lazy and required
DILIGENCE willing and hard but slacks off at watched and pushed
good worker constant pushing
worker at all times other times much of the time
5 Rarely gives Often been in
Has adapted well to Resents discipline Resents discipline
trouble and trouble but accepts
DISCIPLINE discipline and given and carries a chip on and incites. Others
accepts discipline discipline in good
no trouble his shoulder to do likewise
in good spirit spirit
6 Has been entirely Has been generally Generally truthful Proved Cannot be trusted
INTEGRITY trustworthy and trustworthy and with occasional untrustworthy under Has frequently been
dependable dependable lapses stress Found to be disloyal
7 Has always shown a Can be depended Has had to be Often failed to show Cannot be trusted
RESPONSIBILITY high sense of on to do his job. checked periodically a sense of to do his job unless
responsibility Has rarely failed generally reliable responsibility supervised

APPRAISAL FORM Page 1 of 2

8 His work has on His work and Repeatedly been
Has never been seen Has never allowed
occasion been conduct has often drunk. Efficiency
SOBRIETY drunk or suffering drink to affect his
adversely effected been adversely and conduct
from a hangover work
by drink affected by drink seriously affected
9 Always punctual and Has always been
Has never been late Has been frequently
works considerable punctual and will Has occasionally
TIMEKEEPING but is inclined to be late for duty and is
time in excess of call work willingly if been late for duty
a clock-watcher generally unreliable
of duty required to do so
10 Generally in good
Poor health. Very
Always very healthy. Healthy, but condition. Very Bad health
often requests
HEALTH Has physical strength limited physical seldom requests unsuitable for
medical exam, in
for all kinds of duties strength for work medical exam, in seagoing work
port
port
11 LEADERSHIP Very good control
A good control but His control over crew Poor control, which
(officers and over crew and Completely lacking
often has wrong is neither good or sometimes caused
petty officers cooperative with control over crew
idea of leadership bad crew problems
only) officers/Engineers
12 An asset to the A good man. Could Satisfactory worker Cannot recommend
OVERALL Doubtful case.
Company. Suitable be considered for recommended for that he be
ASSESSMENT Recommended given
for promotion promotion with continued continued in
a further chance
anytime more experience employment employment
Remarks:

Company’s
column
Sign Sign

DEPARTMENT HEAD ( ) MASTER ( )

APPRAISAL FORM Page 2 of 2