Staff Performance Evaluation Formi
This performance evaluation is in accordance with the CDC’s Performance
Evaluation Policy. A copy of this form shall be given to the staff member in
advance of the performance appraisal. The staff member and Section Head will
complete the evaluation together.
Staff member:
Job title:
Department:
Supervisor:
Review Period:
RATING SCALE:
5 = Outstanding
4 = Commendable
3 = Meets expectations
2 = Developmental
1 = Does not meet expectations
N/A = Not applicable
EVALUATION:
The following eight (8) factors have been selected to reflect the basic core
competencies and are meant to assist supervisors in considering the
performance of all staff members. The criteria under each factor may not apply to
all staff members.
1
1. Job Knowledge
N/A
1
2
3
4
5
N/A
1
2
3
4
5
Understanding of duties & responsibilities (as per
job description)
Competency in required job skills & knowledge
(as per job description)
Knowledge of current field or practice
Command of critical issues & details
Understanding of the work of the department
Assumes responsibilities consistent with the
position
Overall Rating:
Comment(s):
2. Productivity/Getting Things Done
Uses resources effectively
Works with minimal supervision
Learns & applies new skills
Consistently manages a reasonable workload
Organizes work effectively
Manages overlapping tasks & projects
Establishes effective processes & procedures
Work is consistently of high quality
Overall Rating:
Comment(s):
2
3. Interpersonal Skills
N/A
1
2
3
4
5
N/A
1
2
3
4
5
Listens & comprehends
Responds positively to feedback
Achieves results through/with other people
Resolves conflicts in a professional manner
Participates constructively in teams
Provides constructive feedback
Overall Rating:
Comment(s):
4. Problem Solving
Anticipates potential problems & takes
appropriate action
Gathers & analyzes relevant information
Identifies the root of problems
Generates acceptable alternative solutions
Overcomes obstacles to meet objectives
Overall Rating:
Comment(s):
3
5. Communication
N/A
1
2
3
4
5
N/A
1
2
3
4
5
Select the appropriate communication method(s)
Elicits appropriate & pertinent information
Adjusts style to target audience
Written information is clear, concise & organized
Speaking is clear, concise & organized
Demonstrates effective group interaction skills
Keeps others informed of pertinent information
Overall Rating:
Comment(s):
6. Leadership
Demonstrates confidence in self & others
Establishes clear focus & direction
Is impartial
Sets & achieves objectives with team
Develops a shared sense of purpose
Consults, makes decisions & takes action
Accepts responsibility for work assigned
Recognizes contributions of team members
Is available to other staff
Supports staff skills development
Overall Rating:
Comment(s):
4
7. Professional Responsibility
N/A
1
2
3
4
5
N/A
1
2
3
4
5
Knows professional & personal abilities
Knows professional & personal limitations
Adheres to professional Code of Ethics
Understands when to report unsafe, unethical or
incompetent practice
Maintains competencies of practice
Acts with professional integrity
Overall Rating:
Comment(s):
8. Professional Development
Identifies areas requiring new learning
Identifies learning strategies for new growth
Actively participates in acquiring new knowledge
or skills
Able to put new knowledge, skills & behaviours
into practice
Identifies & uses appropriate resources to
advance professional knowledge, skills &
behaviours
Overall Rating:
Comment(s):
5
9. Please provide comments:
Use additional paper if required
What parts of your job gives you the most
satisfaction?
What parts of your job give you the least
satisfaction?
In the past year, of which professional
achievements are you most proud?
What is your vision for your section,
department, CDC and how will you contribute
to this vision?
What could be done to enhance our
programs/services?
6
GOALS FOR NEXT REVIEW PERIOD
Goal
(Developmental or job specific)
e.g. learn a new assessment,
implement a new classroom
program, etc
Specifics (What will be
done? What support is
needed? When will it be
completed?)
e.g. training on assessment
required
Achievement
(How will you know you have
achieved your goal?)
e.g. complete and score n
assessments within 1 year
Date Achieved
Competency or Strategic
Direction Addressed
e.g. professional
development (competency),
improved service outcomes
(strategic direction)
7
Comments & Signatures:
Job description/job duties reviewed
Yes □
No □
Respect in the Workplace Policy reviewed
Yes □
No □
Confidentiality Policy reviewed
Yes □
No □
Supervisor’s Comments:
Recommend pass of probation (for probationary employees only): Yes □ No □
Supervisor’s Signature
Date
Staff Member’s Comments:
I have reviewed the performance appraisal & discussed the contents with my
supervisor. My signature means that I have been advised of my performance
status and does not necessarily imply that I agree with the evaluation. In the
event that I disagree with the evaluation, I will submit a written objection letter.
Staff Member’s Signature
Date
i
Adapted from UVic Professional Staff Member Performance Appraisal Form. Retrieved August 12, 2009
from http://web.uvic.ca/uvicpea/Review.htm.
8