PT. XYZ Jl.

Istana Merdeka
Jakarta

PERFORMANCE EVALUATION SHEET

Employee's Data 1st Evaluator (Direct Supervisor) : Accounting Manager Grade :

Name Mr./Ms. X 2nd Evaluator (Work Colleague) : Chief of Finance 5 = Very good
Position Chief of Accounting 3rd Evaluator (Direct Subordinate) : Accounting Staff 3 = Sufficient
Department Finance, Accounting & Tax Evaluation Period : 12 months 1 = Lacking
Working Period 12 months Date of Evaluation :Dec 2012

Weight 1st Evaluator (50%) 2nd Evaluator (30%) 3rd Evaluator (20%) Final Grade :
Evaluation Criteria G GxB G GxB G GxB Exceptional = 18< x <20
1 Work Quality 1 5 5 5 5 5 5 Excellent = 16< x <18
2 Dutifulness 1 5 5 5 5 5 5 Good = 14< x <16
3 Team work 1 5 5 5 5 5 5 Average = 12< x <14
4 Initiative 1 5 5 5 5 5 5 Insufficient = below 12
TOTAL 4 Sub Total 1 20 Sub Total 1 20 Sub Total 2 20

Attendance and Discipline (filled by HRD) Score : [Sub Total 1 x50%] + [Sub Total 2 x 30%]+[Sub Total 1 x20%]
Score = 10 6 4 = 20
Overdue Sick leave Permit

1 x days 3 x . days 5 x . days Final Grade: Score -- Attandance deduction

Absence Warning letter Memoranda Exceptional 20

15 x days (- 30)/letter (- 50)/memoranda
0 0 0
 INDO KAYA ENERGI Patria Park Office No.16
ENERGI SERVICES Jl. DI Panjaitan Kav. 5-7, Jakarta, 13340

Phone: +6221 85906560

FORM PENILAIAN KINERJA TAHUNAN

Karyawan Staff

IDENTITAS PEKERJA PENILAI 1 (Atasan Langsung) : Imas Puspitasari Grade :

Nama Mr. / Ms. X PENILAI 2 (Ka.Dept.) : Devi Nugrahayu 5 = Sangat baik
Bagian Admin Tender PENILAI 3 (General Manager) : Roes Arief Budiman 4 = Baik
Dept. Marketing - Tender Admin Periode Penilaian : 1 Tahun (Jan - Des 2011) 3 = Cukup Final Grade :
Masa kerja 11 Bulan / Oct'2010 Tanggal Penilaian : Des 2011 2 = Kurang A = 421 - 500

Bobot Penilai 1 (50%) Penilai 1 (30%) Penilai 2 (20%) B = 341 - 420

KRITERIA PENILAIAN G GxB G GxB G GxB C = 261 - 340
1 Kualitas Kerja 25 4 100 3 75 3 75 D = < 261
2 Kepatuhan 25 3 75 3 75 3 75
3 Kerjasama / Team Work 25 4 100 3 75 3 75 Ttd Penilai 1 Ttd Penilai 2
4 Inisiatif 25 3 75 3 75 3 75
JUMLAH 100 Sub Total 1 350 Sub Total 1 300 Sub Total 2 300
PENILAIAN ABSENSI & DISIPLIN (Diisi oleh HRD) Score : [Sub Total 1 x50%] + [Sub Total 2 x 30%]+[Sub Total 1 x20%]
Datang Lambat / Lupa Score = 175 90 60 = 325
Catat Sakit Ijin

1 x hari 3 x . hari 5 x . hari Final Grade / NILAI AKHIR : Score -- Potongan Absensi Catatan :

Mangkir Surat Teguran Surat Peringatan D 275 Pekerja yang mendapat Surat Peringatan
tidak berhak mendapat Final Grade "B"
15 x hari (- 30)/kali (- 50)/kali
1x