DISTRICT HEALTH & FAMILY WELFARE SOCIETY

PERFORMANCE APPRAISAL
(General Format and Performance Score Card)

General Format
For the period April 2023 to March 2024

Name ( in Block Letters )

Designation & Programme

Draft #7 of File NHM/1558/ADMIN1/2024/SPMSU Approved by State Mission Director on 16-May-2024 12:38 PM - Page 1

Name of the Institution

Age & Date of Birth Years / /

Date of Entry in NHM
Date of entry in the present post
Consolidated Pay
Earned
Casual leave LOP No. of
Leave Total Leave
Details of leave availed except eligible Availed (days) approved(days) Leave not
approved (C days(A+B+C)
maternity leave (A) (B) approved
)
From 2nd April 2023 to 31st March 2024

% of attendance as on 31st March 2024

Total no. of days present x 100
Total No. of working days (subject to 80 % of
attendance during the contract period)

Maternity Leave in days, if any approved

Memos / Disciplinary action during the

Show Cause
Contract Period. Verbal Warning Memo
Notice

(Details shall be attached separately)

EDUCATIONAL QUALIFICATIONS

Sl no Qualification Institution studied University affiliated

 WORK EXPERIENCE FROM LAST TWO EMPLOYERS

Sl No Organization Designation From To Nature of Work

PERFORMANCE
A B C D
Factors Total Marks
(2.5 Marks) (2 Marks) (1.5 Marks) (1 Mark)
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Cannot perform
Resourceful &
without close
original in giving Shows reasonable Mark
Tends to wait for supervision and Mark
suggestions and degree of initiative (Immediate
Initiative and direction guidance. Limited (Self)
pursues them and resourcefulness Officer)
Resourcefulness desire to achieve
constructively
task Mark
(DPM)
Self Officer Self Officer Self Officer Self Officer

Exceptionally Indifferent to
Always punctual, Mark
punctual in all to follow the general general code of Mark
observes the code of (Immediate
matters and code of conduct conduct. Shirks (Self)
Discipline conduct Officer)
exemplary conduct responsibility
Mark
(DPM)
Self Officer Self Officer Self Officer Self Officer

Very conscientious
Reasonably
Responsibility and dependable in
A steady worker with a conscientiousness Often fails to Mark
and Dependability the performance of Mark
good record of and does his / her perform his / her (Immediate
Sincerity of his / her job. Always (Self)
dependability job in a routine duty Officer)
responsibility and ready to take
manner
Conscientiousness responsibility Mark
towards duty (DPM)
Self Officer Self Officer Self Officer Self Officer

Extremely
Co-operation and Cooperative, Always cooperative
Co-operative
Personal relations maintains and generally Mark
maintains with effort Does not get along Mark
Co-operation with outstanding good maintains with effort (Immediate
reasonably good well (Self)
superior and relations, all round reasonably good Officer)
relations
colleagues and earning respect from relations
Mark
personal relations his/her colleagues
(DPM)
with public where
relevant Self Officer Self Officer Self Officer Self Officer
 Indifferent in the Mark
Takes adequate Does his / her work Mark
Takes keen interest discharge of his / (Immediate
Interest in the interest in a routine away (Self)
her duties Officer)
assignment
Mark
(DPM)
Self Officer Self Officer Self Officer Self Officer

Job Knowledge
Has an unusually
Technical and
thorough and
general knowledge Knowledge
comprehensive Possesses just Mark
about the job, he / Knows his / her job inadequate. Has Mark
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mastery of his/ her adequate knowledge (Immediate

she is doing thoroughly not yet gained (Self)
field of work. Strives required of the job Officer)
a) General (of his competence
to expand his / her
and related Mark
frontier of knowledge
subjects of (DPM)
versatility) Self Officer Self Officer Self Officer Self Officer
b) of work
c) Up-to-darkness

Noting, Drafting Ordinary at noting

Very precise in
and and drafting. His /
noting and drafting. Precise in Noting and
Correspondence her drafts need Poor in noting and
Very prompt and Drafting. Good at Mark
Ability to prepare editing. Tries to drafting - Careless Mark
accurate at correspondence. His / (Immediate
notes, drafts and handle in handling (Self)
correspondence. His / her drafts seldom Officer)
handle correspondence in correspondence
Her drafts need no require editing
correspondence time if properly Mark
editing
with special supervised (DPM)
reference to- Self Officer Self Officer Self Officer Self Officer
1) Accuracy
2) Thoroughness
3) Power of
analysis
4) Power of
expression

Quality and
Quantity of work
Quantom of work Distinguished output Turns out more than Output and quality Mark
Adequate output Mark
to be done, of work both in adequate volume of regularly (Immediate
and quality (Self)
quantinum actually quantity and quality work of good quality insufficient Officer)
done and the
Mark
promptness
(DPM)
with which it is
Self Officer Self Officer Self Officer Self Officer
done

Lacks ability to
Exceptionally skilled
Able to convey ideas Moderate ability to convey ideas in
in conveying ideas in
in clear logical and convey ideas and clear, logical and Mark
Ability to clear, logical and Mark
convincing manner. moderately convincing manner. (Immediate
communicate and convincing manner. (Self)
Receptive to ideas of receptive to others Not Officer)
Receptiveness to Extremely receptive
others ideas receptive to others
ideas of others to ideas of others Mark
ideas
(DPM)
 Self Officer Self Officer Self Officer Self Officer

Attitudes /
Fails to solve the
achievements in Extremely alert in Always takes keen Usually analyses the Mark
problems of Mark
the tackling the problems interest in solving the problems and finds a (Immediate
vulnerable and (Self)
implementation of of downtrodden problems of vulnerable solution Officer)
marginalised
programmes
Mark
(DPM)
Self Officer Self Officer Self Officer Self Officer
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SCORE SHEET
Self Assessment Immediate Supervisor's Assessment DPMs Assesment
Sl.No.
Marks Scored Points Total Marks Scored Points Total Marks Scored Points Total

1 2.5 2.5 2.5

2 2 2 2
3 1.5 1.5 1.5
4 1 1 1
Total Total Total

DECLARATION
I do hereby affirm that the details given in the performance appraisal and above said formats are true to the best of my
knowledge and belief.

Name & Signature of the Employee

Remarks and Recommendation of Concerned Reporting Officer

Approval Valid
Digitally Approved By
Jeevan Babu K. I.A.S
Date: 16.05.2024
Reason: Approved
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