Employee Self Evaluation Form

I. EMPLOYEE INFORMATION
Employee Name Job Title

Supervisor/Reviewer Review Period

From: / / To: / /
II. CORE VALUES AND OBJECTIVES
PERFORMANCE CATEGORY RATING COMMENTS AND EXAMPLES
Quality of Work:  Exceeds expectations
Work is completed accurately (few  Meets expectations
or no errors), efficiently and within  Needs improvement
deadlines with minimal supervision  Unacceptable

Attendance & Punctuality:  Exceeds expectations

Reports for work on time, provides  Meets expectations
advance notice of need for  Needs improvement
absence  Unacceptable

Reliability/Dependability:  Exceeds expectations

Consistently performs at a high  Meets expectations
level; manages time and workload  Needs improvement
effectively to meet responsibilities  Unacceptable

Communication Skills:  Exceeds expectations

Written and oral communications  Meets expectations
are clear, organized and effective;  Needs improvement
listens and comprehends well  Unacceptable

Judgment & Decision-Making:  Exceeds expectations

Makes thoughtful, well-reasoned  Meets expectations
decisions; exercises good  Needs improvement
judgment, resourcefulness and  Unacceptable
creativity in problem-solving

Initiative & Flexibility:  Exceeds expectations

Demonstrates initiative, often  Meets expectations
seeking out additional responsibility;  Needs improvement
identifies problems and solutions;  Unacceptable
thrives on new challenges and
adjusts to unexpected changes

Cooperation & Teamwork:  Exceeds expectations

Respectful of colleagues when  Meets expectations
working with others and makes  Needs improvement
valuable contributions to help the  Unacceptable
group achieve its goals

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III. JOB-SPECIFIC PERFORMANCE CRITERIA
PERFORMANCE CATEGORY RATING COMMENTS AND EXAMPLES
Knowledge of Position:  Exceeds
Possesses required skills, expectations
knowledge, and abilities to  Meets expectations
competently perform the job  Needs improvement
 Unacceptable

Training & Development:  Exceeds

Continually seeks ways to
strengthen performance and
regularly monitors new
developments in field of work
expectations
 Meets expectations
 Needs improvement
 Unacceptable

IV. PERFORMANCE GOALS

Set objectives and outline steps to improve in problem areas or further employee development.

V. OVERALL RATING

 EXCEEDS EXPECTATIONS  MEETS EXPECTATIONS  NEEDS IMPROVEMENT  UNACCEPTABLE

Employee consistently Employee satisfies all Employee consistently Employee is unable or
performs at a high level essential job performs below required unwilling to perform
that exceeds requirements; may exceed standards/expectations for required duties
expectations expectations periodically; the position; training or according to company
demonstrates likelihood of other action is necessary to standards; immediate
eventually exceeding correct performance improvement must be
expectations demonstrated
Comment on the employee's overall performance.

VI. EMPLOYEE COMMENTS (OPTIONAL)

VII. ACKNOWLEDGEMENT

I acknowledge that I have had the opportunity to discuss this performance evaluation with my manager/
supervisor and I have received a copy of this evaluation.
Employee Signature: Date:

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Reviewer Signature: Date:

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