Performance Appraisal Form

Section A

Employee Name Agnes Rosline .I Grade Level G-VI

Employee Code VHBPL3332 Reporting Manager Dr. Zulfi Rubiya

Job Title Medical Transcriptionist Reviewer Dr. Harshitha

Department MRD Period of Appraisal March 2020 - April 2021

Section B1. Result-oriented Goals

Customer/ Operations - related (Overall Weightage: 20-60%)

Goals for 2020 – 2021

Sl. No (Patient focus / Satisfaction, Special Projects, Measure Weightage for each Goal Support from Nature of Support Self- Rating Supervisor Rating
Operations, Efficiency & related aspects)

100% error free

1 Ultrasound 15 Doctors 4
documentation

100% error free

2 X-rays 15 Doctors 4
documentation
100% error free
3 CT/MRI 10 Doctors 4
documentation

a. Interacting with Patients, (b) Handling Work 100% customer

4 15 Self 4
pressure, (c) Flexible with Shift timings satisfaction

Justification for Self - Rating:

My focus is on preparing error free reports and concentrate on dictation given by the doctors.
------- " --------
I have weighed myself 10 since I have few errors due to fast pace dictation, which I have rectified myself and it as has not been repeated.
Interacting with patients during ultrasound so that they are comfortable.
Justification for Supervisor Rating:
1
2
3
4

Job knowledge/Process - related (Overall Weightage: 20-60%)

 Goals for 2020 – 2021
Sl. No (Compliance to procedures / standards, Process Measure Weightage for each Goal Support from Nature of Support Self- Rating Supervisor Rating
improvements, New technology implementation)

1 Accurate reports Concentration 20 Doctors 5

2 Patient Handling Patience with Patients 15 Self 5
3 Be Content Be Content 15 Self 5
Understand the
4 Initiative
requirement of Senior

Justification for Self-Rating:

1
2
3
4
Justification for Supervisor Rating:
1
2

3
4

Self-development/Team development (Overall Weightage: 15-20%

Sl. No Goals for 2020 – 2021 Measure Weightage for each Goal Support from Nature of Support Self- Rating Supervisor Rating
(Training, multi skilling, team development etc)

1
2
3
4
Justification for Self-Rating:
1
2
3
4
Justification for Supervisor-Rating:

1
2
3
4

Section B2. Exceptional contributions - 'Beyond the call of duty'

Sl. No Nature of Activity (Time, date, place, action) Benefit (Crisis handling, averting any major mishaps, de-bottlenecking issues,
productivity improvements)

Individual comments
Individual comments

Supervisor
comments

Individual's signature

Supervisor signature

Section C - Behavior-related Goals

Guidelines for Rating :
1. '5' rating - 100% of the boxes are checked.
2. '4' rating - 81-99% of the boxes are checked.
3. '3' rating - 71-80% of the boxes are checked.
4. '2' rating - 61-70% of the boxes are checked.
5. '1" rating - <60% of the boxes are checked.
• Treats others fairly and
with respect.
Behavior Description • Takes responsibility
Measure for Self- reating Justification Supervisor Rating Justification
own work, including
problems and issues. ✔
• Uses applicable ✔
professional standards
and established
•Assumes
procedures, personal
policies
responsibility
and/or legislation and when
follows
Integrity Demonstrates behaviours consistent with the organization’s values up to meet commitments
taking action and making
to others.
decisions.
•Understands
• Identifies ethical the goals of ✔
the
dilemmasteam andandeach team
conflict of
member’s role
interest situations within
andit.
•Deals
takes actionhonestly and fairly
to avoid and
with
prevent others, showing
them. ✔
consideration
• Anticipates and andprevents
respect. ✔
•Willingly
breaches ingives support to
confidentiality ✔
co-workers
and/or security. and works
collaboratively rather than
competitively. ✔
•Shares experiences, ✔
knowledge and best
practices with team
members. ✔
Team Player Participates as a team member and fosters teamwork
•Assumes responsibility ✔
for work activities and
coordinating efforts.
• Promotes team goals. ✔
• Seeks others’ input and
involvement and listens to
•their
Open to change and
viewpoints.
participates effectively
• Shifts priorities, changesin
process
style andimprovement
responds with
changes.
new approaches as
•needed
Is flexible and adapts
to meet team to
different ✔
goals. methods of
achieving work-related
• Suggests or develops ✔
goals.
methods and means for
•maximizing
Identifies and accepts ✔
Learning Receptive to new learning the input and
the need andof
involvement processes
team
for change.
members.
• Explains the process and
rationale for change to
those affected by it.
• Invites discussion of
views on the change.
 • Identifies client needs
and expectations.
• Responds to requests
efficiently and effectively.
•Takes action beyond
explicit request within ✔
established service
standards. ✔
• Refers complex
questions to a higher
Commitment decision- making level.
Commitment and dedication to work • Meets client needs in a ✔
respectful, helpful and
responsive manner.
• Seeks feedback to
develop a clear
•Makes self available
understanding and
of client
clearly
needs andencourages
outcomes.others
to initiate communication.
• Uses client satisfaction
•Listens
monitoringactively and
methodologies
objectively without
to ensure client ✔
interrupting.
satisfaction ✔
•Checks own
Communication Transparency in communication with patients , family members & Colleagues understanding of others’
communication (e.g., ✔
repeats or paraphrases,
asks additional questions). ✔
•Presents appropriate
information in a clear and
concise manner, both
orally and in writing.
✔
• Demonstrates safe work
habits and knowledge of ✔
all related requirements
and practices relative to
job assignment.
Safety Safety • Completes incident
reports according to policy
for any adverse events.
• Follows all established
infection control practices.

Signature of the Appraisee:

Section D - HR The HR Department is to make a record of the events related to the following:

Attendance
Leave
Discipline
Reward &
Recognition history
Exceptional
contributions (B2)

HR Manager: Overall
Remarks / Signature:

Section E - Overall Rating

Overall Rating given

to the employee

Supervisor - Overall
Remarks / Signature:

Reviewer - Overall
Remarks / Signature:
 Section F - Employee Development

Mandatory Training Programs to be attended during the year 2020-2021

Sl. No Name of the Training Program

Self-development Programs to be attended to address specific needs

Sl. No Name of Program To address what need

Signature of the
Appraisee:

Signature of the
Supervisor:
 Level Integrity Team Player Learning Commitment Communication Safety
Transparency in
Demonstrates behaviours Participates as a team
VH - 7 consistent with the member and fosters Receptive to new Commitment and communication with Safety
learning dedication to work patients , family members
organization’s values teamwork
& Colleagues

Transparency in
Identifies ethical Receptive to new Commitment and communication with
VH - 6 implications
Fosters teamwork
learning dedication to work patients , family members
Safety
& colleagues

Encourage
Transparency in
Aligns team with the continuous
Demonstrates Manages the process Anticipates and communication with
VH - 5 organization's values and
Leadership in teams for change adapts to client needs patients , family members
improvements in
ethics the safety
& colleagues
practices

Aligns change
Promotes the Capitalizes on
initiatives with Fosters a client - Communicates complex Demonstrates a
VH - 4 & 3 organization's values and teamwork
organizational focused culture messages culture of Safety
ethics opportunities
objectives

Exemplifies and
demonstrates the Builds bridges Considers the
VH - 2 organization's values and between different Champions change strategic direction of Communicates strategically NA
ethics teams client focus