AZN/HR/009

PERFORMANCE APPRAISAL FORM

Name: Joined date:

Position: Date in position:
Date of Last Appraisal: Appraisal date:
Appraised by: Position:

SECTION I
Reviewer I Reviewer II
Self Appraisal
NO DESCRIPTION Excellent Very Good Good Need Poor / Appraisal Appraisal
Improvement Inadequate Rating Rating
5 4 3 2 1
DEPENDABILITY / KEHANDALAN
1 DEPENDABILITY
KEHANDALAN
Work conscientiously
according to instruction.
Ketidak tergantungan
dalam bekerja sesuai
dengan instruksi.

2 ATTENDANCE
KEHADIRAN
Amount of excessive
absenteeism/lateness
Tingkat kehadiran dan
keterlambatan
WORK CONDUCT / PERILAKU KERJA
3 COOPERATION
KERJASAMA
Willingness to cooperate
and carry out demands
Kemauan bekerjasama
& melaksanakan tugas

4 ATTITUDE
SIKAP
Courtesy, cooperation
with guest & co-worker
Sopan, hubungan baik
dengan tamu & teman
sekerja
5 INITIATIVE /
EMPOWERMENT
INISIATIF /
PENGAMBILAN
KEPUTUSAN
Thinks constructively &
originates action
Berpikir membangun &
inisiatif melakukan tindakan
WORK HABITS / KEBIASAAN KERJA
6 QUANTITY
KUANTITAS
Output of satisfactory
work
Hasil dari pekerjaan

7 ADAPTABILITY
ADAPTASI
Ability to learn and meet
changed condition
Kemampuan belajar
dan beradaptasi

8 SAFETY AND
SANITATION
KESELAMATAN DAN
KESEHATAN KERJA
Complies with safety &
sanitation rules
Menaati peraturan
keselamatan dan kesehatan
 Reviewer I Reviewer II
Self Appraisal
NO DESCRIPTION Excellent Very Good Good Need Poor / Appraisal Appraisal
Improvement Inadequate Rating Rating
5 4 3 2 1
9 QUALITY
KUALITAS KERJA
Performance in meeting
quality standards &
customer service
expectation
Pencapaian standar
kualitas dan harapan
tamu
10 JOB KNOWLEDGE
PENGETAHUAN
TENTANG KERJA
Understanding in all
phases of his work
Mengerti semua aspek
pekerjaan
APPEARANCE / PENAMPILAN
11 GROOMING
PENAMPILAN
Attitude of always
paying attention on his
appearance to give a
good impression
Sikap dalam berpenam-
pilan dalam memberi
kesan baik
12 GROWTH POTENTIAL
POTENSI UNTUK MAJU
Potential ability to lead
and teach others
Potensi unt memimpin
& membimbing orang
lain

SUPERVISOR AND MANAGER ONLY

13 TRAINING
PELATIHAN
Ability to develop others
Kemampuan dalam
mengembangkan orang
lain

14 COUNSELING
KONSULTASI
Provide relevant sup-
port & encouragement
Pemberikan dukungan
dan dorongan

15 PLANNING
PERENCANAAN
Develop activity
schedule to meet
department objectives
Membuat jadwal kegiat
an untuk mencapai
tujuan departemen

16 ANALYTICAL ABILITY
KEMAMPUAN
MENGANALISA
Abilty to think through
evaluate situations and
to find causes for and
solutions to problems
Kemampuan untuk
berpikir, mengevaluasi
situasi & menemukan
penyebab permasalahan
dan jalan keluarnya

OVERALL PERFORMANCE Excellent Very Good Good Need Poor

Improvement Inadequate
SECTION II
RESULT ON PERSONALITY AND JOB PERFORMANCE
HASIL TERHADAP KEPRIBADIAN DAN KINERJA KERJA
*) Diisi oleh employee

SECTION III
KEY RESPOPNSIBILITIES / TANGGUNGJAWAB POKOK
List Out the major responsibilities, primary duties or important functions of this employee
Susun daftar tanggungjawab pokok, tugas utama atau fungsi penting karyawan
*) Diisi oleh employee

SECTION III
EMPLOYMENT DEVELOPMENT SECTION / BAGIAN PENGEMBANGAN KARYAWAN
*) Diisi oleh employee & Reviewer Appraisal
In what area does the employee need to improve? In what areas does the employee excel?
Hal mana yang perlu ditingkatkan oleh karyawan? Hal mana yang sudah baik?

SECTION III
INDIVIDUAL TRAINING AND DEVELOPMENT
RENCANA PENGEMBANGAN DAN PELATIHAN PERORANGAN
List plan to overcome areas of development identified
Sebutkan rencana untuk menembangkan area yang perlu ditingkatkan
*) Diisi oleh employee & Reviewer Appraisal

SECTION IV
EMPLOYEE/APRAISOR DISCUSSION / DISKUSI KARYAWAN/PENILAI
*) Diisi oleh employee & Reviewer Appraisal
GOALS CAREER
 EMPLOYEE COMMENT / KOMENTAR KARYAWAN

SECTION V
APPRAISOR COMMENTS AND RECOMMENDATION / KOMENTAR DAN REKOMENDASI PENILAI

SIGNATURE AND DATE / TANDA TANGAN DAN TANGGAL

Agreed by:
Employee Date Appraisor Date

Agreed by:
Department Head Date Division Head Date

Agreed by:
HR Manager Date General Manager Date