(A Unit of Guntur Institute of Oncology Pvt.

Ltd)

PERFORMANCE APPRAISAL

This evaluation is for: Periodic Review Annual Appraisal Confirmation

Name: Date of Appointment:

Emp. Code: Present Salary:
Qualification: Appraisal Period:
Designation: Department:
General Instructions:
1. The purpose of this form is to assess the persons working with you on the following major criteria

Personality Performance Potential

2. Performance evaluation should be restricted to the period under review.

3. This form contains 2 parts

a. Part – I

i. Should be completed by the Employee Self (ES) & Head of the Department (HOD)

b. Part – II - To be completed by HOD

Head of the Department Review (HOD)

4. Ratings will be given on a 10 points scale as under:

a. 9-10 - Outstanding
b. 7-8 - Above Average
c. 5-6 - Average
d. 3-4 - Below Average
e. 2-1 - Poor
(A Unit of Guntur Institute of Oncology Pvt. Ltd)
PART – I
FORM “A” PERSONALITY

RATING
(Award on a rating scale
CRITERIA of 1 to 10)
ES HOD

1. APPEARANCE AND BEARING

(Personal Grooming, Social Conduct/Manners & Etiquettes)
2. KNOWLEDGE
a. Knowledge of jobs of your department
b. Knowledge and ability to do jobs of other departments
c. Knowledge of the latest development related to your work
3. SKILL
a. i. Forecasting (ability to predict/anticipate)
- Logical ability
- Ability to visualize the course of events
ii. Planning
(Proper use of resources)
iii. Organizing
(Distribution of work / groups)
b. Coordinating
(Inter group relationships)
c. Computer skills
- Microsoft word
- Microsoft Excel
- Typing Speed
- Other applications
4. COMMUNICATION SKILLS
a. Verbal Communication
b. Written Communication
c. Body Language
FORM “A” (Contd.)
(A Unit of Guntur Institute of Oncology Pvt. Ltd)
RATING
(Award on a rating scale
CRITERIA of 1 to 10)
ES HOD

5. ATTITUDE
(Towards juniors/colleagues/seniors)
- Interpersonal relations
- Commitment to Omega
- Ability to accept criticism, suggestions, willingness to accept
personal inconveniences and discomforts for the sake of the
institution and other people
- Responsible for actions and results
6. INTEGRITY AND MORAL COURAGE
Has displayed honesty, courage and is straight forward in personal and
professional dealings
7. LOYALTY
Organization comes first
8. DEPENDABILITY
Ability to complete given work independently, in time and as per the
expected standards
9. INITIATIVE
Likes to take lead in any situation
Ability to think beyond the present
10. DRIVE
Has enthusiasm and zeal in doing work
Ability to inspire others to do the same
11. MATURITY
Ability to take wise, balanced and fair decisions through experience
12. STAMINA
Ability to take mental and physical stress during difficult situations

FORM “B” PERFORMANCE

(A Unit of Guntur Institute of Oncology Pvt. Ltd)
RATING
(Award on a rating scale
CRITERIA
of 1 to 10)
ES HOD
1. ADAPTABILITY
Ability to adjust with new people
Ability to adapt to different conditions and circumstances
2. RESULT ACHIVEMENT
Has been able to achieve results as per set targets in terms of quantity,
quality and time
3. QUALITY OF WORK
Does work with minimal errors
4. ACHIEVEMENTS
Cost Saving
5. PUNCTUALITY
Comes to office, meetings and other gatherings on time
6. DISCIPLINE
Had no or less disciplinary action taken, less or no fines, follows senior’s
instructions etc.
FORM “C” POTENTIAL

RATING
(Award on a rating scale
CRITERIA of 1 to 10)
ES HOD
7. MULTI DISCIPLINARY KNOWLEDGE
8. APPRAISING ABILITY
Ability to judge self and others accurately
9. LEADERSHIP QUALITY
Has the ability to control, motivate and set personal examples, ability to
create expectations of success and infuse trust
10. TEAM BUILDING CAPABILITY

TOTAL MARKS
(A Unit of Guntur Institute of Oncology Pvt. Ltd)
PART II

RECOMMENDATION FOR INCREMENT / PROMOTION

SUMMARY AND OVERALL EVALUATION:
(Describe the individuals’ special qualities, achievements and failures, if any)

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

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IN CASE OF ANNUAL APPRAISAL:

NORMAL PROPOSED INCREMENT PROPOSED: _________________

PROMOTION: Is He/She promotable: Yes No

If yes, from (position) __________________________ to (position) ___________________________

FINAL REMARKS (HR):

________________ _____________________ ________________ ___________________________

HOD Sign Sr.Manager-HR Sign GM - Operations CEO & Medical Director Sign