Indira Television Limited

Employee Self-Evaluation Form

Employee Name Designation: Department:

Employee Code
Location: Reporting to: Date of Joining:

Please list down 5 key goals and accomplishments for FY- 22- 23 and mention the measurable results which demonstrate that
you have achieved your goals.

Measurable Target/goals: Measurable result of your goals:

Additional Comments / Support required in 23-24 – to achieve higher results

Please rate your overall performance (Please tick the relevant box)

☐ OS - Outstanding
☐ EE - Exceeds
Expectations
☐ OT - On Target
☐ NI – Needs Improvement
☐ US - Unsatisfactory
Employee was able to exceed the budgeted performance by more than 20% of the assigned
goals and objective.
Employee was able to exceed the budgeted performance by 10 – 20%. Employee has
performed very well and has been able to exceed the expectation significantly.
Employee was able to meet his/her budgeted targets and is 100% on budgeted performance
as per agreed upon KPI’s
Employee was unable to achieve the budgeted targets but has been able to achieve 50-60% of
what was budgeted.
Employee has not performed as per expectation and is <60% of budgeted targets

Employee Signature: _ _ Date: _

To be filled by the respective immediate supervisor in discussion and consultation with the employee.

Do you agree with the overall goals, outcome and employee self-rating? Yes No

Provide your justification, observations and development areas about the employee (By Supervisor)

Provide your justification about the employee (By Head of the department- Optional)

Please rate overall performance of the employee (Please tick the relevant box)

Ratings by Supervisor
☐ OS - Outstanding
☐ EE - Exceeds Expectations
☐ OT - On Target
☐ NI – Needs Improvement
☐ US - Unsatisfactory

Signature of the Supervisor Signature of the Head of the Department