No :

EMPLOYEE ANNUAL APPRAISAL Rev :

WORK PERFORMANCE REVIEW Date :

Page : 1 of 3

== Form for Supervisor Level & Above ==

Employee Name Betman Hutabarat Grade / Job Title Mine Eng

Employee ID. DPM 0161 Division / Department Tehnical

Joined Date 1/8/2021 Appraisal Period 2023

GUIDELINES IN COMPLETING THE FORM SCORE CRITERIA

The appraisal has to be done in form of a discussion between appraiser - appraise. Employee should do a self appraisal 4 Satisfactory (extraordinary performer)

before the discussion takes place. 3 Very Good (exceeds expectation)

2 Good (as per expectation)

This form is for Supervisory and above level
1 Need Improvement (below expectation)

Form must be filled completely, especially next year proposed training column

APPRAISAL FACTOR (A) - BASIC SKILLS WEIGHTING

SCORE ACHIEVED SCORE
NO (%) (Weighting x Score)
- For All Levels - Employee Appraiser

PASSIONATE
Indicators: Provides sincere and consistent level of service, continuously looks for better ways to
serve others and apply solutions.
1 Continuously looks for better ways to serve others and apply solutions. 15% 2 0
Proactively maintains relationships with others and knows when the other does not
want to be engaged.
Anticipate others' personal preferences an exceeds expectations.

PROFESSIONALISM
Indicators: Stays calm and attentive, exhibits concern regardless of the circumstances.
Shows a sense of professionalism in language and manner, e.g. clam, speak politely,
2 10% 3 0
addresses others with respect; courteous under pressure.
Uniform and appearance always look crisp and fresh; demonstrates high level of
attention to grooming.
ETHICS FOR WORK
Indicators: Voluntarily offers to work additional shifts or hours due to high demands in
operations.
Delivers high quality of service in a quick and efficient way - consistently improve the
level of service and anticipate others' needs.
3 Regularly provides high-quality results in a timely manner. 10% 2 0
Seeks for continuous improvement opportunities and takes an action without being
asked.
Provides a clear and transparent communication to keep trust and maintain integrity.

Continuously improve knowledge for job effectiveness.

COMMUNICATION SKILLS
Indicators: Communicates clearly and precisely, able to expresses ideas directly to others,
peers, subordinates and superiors.
Uses verbal and body language that shows enthusiasm to assist others.
4 15% 3 0
Able to feel when communication is not understood and can adapt communication
accordingly.
Paraphrases what has been heard to check the understanding of the intended
message.
TEAM PLAYER
Indicators: To be a role model for others; give assistance to others without being asked.
Consistently shows sensitivity and values others.
Works with subordinates, peers, supervisors and senior management to build
5 15% 2 0
relationships based on trust and honesty.
Actively promotes and encourages the group's efforts.
Pursues the goals of the group actively.
Provides tasks to serve others regardless the status.
 No :

EMPLOYEE PERFORMANCE APPRAISAL Rev :

WORK PERFORMANCE REVIEW Date :

Page : 2 of 3

APPRAISAL FACTOR (A) - BASIC SKILLS WEIGHTING

SCORE ACHIEVED SCORE
NO
(%)
- For All Levels - Employee Appraiser
(Weighting x Score)

ADAPTABILITY
Indicators: Communicates ideas and discusses them with management before implementation.
Adjusts quickly schedule according to priorities; understands changing and responds proactively.
Prioritizes and handles tasks efficiently and effectively.
6 10% 2 0
Finds solutions to challenges calmly.
Actively looks for feedback to improve behavior to meet company and others' needs.
Enthusiastic to changes; actively supports and participates in new programs and policies.
Seeks for assistance before a problem occurs.

PRACTICAL COMPETENCIES
Indicators: Actively supports and participates in the departmental and company training programs.
Responds proactively to complaints from others and follows them up in accordance with procedure.

Understands the safety procedures and consistently apply them in all aspects of work.
7 Consistently execute the opening and closing of the day in accordance with the procedures. 15% 2 0
Good knowledge about the the industry and able to explain them when requested.
Consistently performs the SOP in work duties.
Maintains inventory to ensure that all necessary stock is available at all times.
Always improve productivity and motivation to maximize the maximum result in the positive
manner.

ATTENDANCE

8 Indicators: Always come in time prior to schedule - perfect attendance/no absenteeism, no tardiness, always 10% 3 0
flexible with scheduling based on operational needs.

TOTAL SCORE - A 100% 0.0

APPRAISAL FACTOR (B.1) - SUPERVISORY-MANAGERIAL SKILLS WEIGHTING

SCORE ACHIEVED SCORE
NO
(%)
- For Supervisor Level & Above - Employee Appraiser
(Weighting x Score)

PROBLEM SOLVING & DECISION MAKING

Indicators (+): Able to identify problems, analyze possibilities and provide guidance in decision-making
1 10% 2 0
Indicators (-): Unable to anticipate problems, decisions taken lead to other problems, frequent mistakes when
analyzing problems

LEADING & DEVELOPING PEOPLE

Indicators (+): Able to influence others to achieve goals, develop potential subordinate, support every effort made
2 by others, and appreciate every result 10% 2 0
Indicators (-): Use 'power' to achieve his/her goal, do not appreciate the efforts of subordinates, if there is a
problem likely to avoid responsibility

CULTURAL AWARENESS
Indicators (+): Understand and take part of a global culture of the company and does not discriminate in
3 employment 10% 2 0
Indicators (-): Show favorites in persons, be unfair in deciding things, be prejudiced and suspicious and negative
thinking

CUSTOMER FOCUS (customer: other employees who expects our service/products/competencies/knowledge/idea/inputs)

Indicators (+): Build and maintain relationships with customers, understand customer needs and wants, as well as
4 meet customer expectations 10% 0
2
Indicators (-): Rarely do the communication with customers, insensitive to the needs of customers, and each
customer's problems can not be solved

IMPACT & INFLUENCE

Indicators (+): Promoting ideas/suggestions in persuasive way, able to influence others to produce positive
5 results, build consensus for target achievement 10% 2 0
Indicators (-): Fear that other person exceeds his ability, tend to be reluctant to share. Ideas/suggestions are
rarely accepted by the group

TOTAL SCORE - B.1 Supervisory-Managerial Skills 50% 0.0

 No :
EMPLOYEE PERFORMANCE APPRAISAL Rev :
WORK PERFORMANCE REVIEW Date :
Page : 3 of 3
APPRAISAL FACTOR (B.2) - CRITICAL TASKS/ASSIGNMENTS WEIGHTING SCORE ACHIEVED SCORE
NO
- For Supervisor Level & Above - (%) Employee Appraiser (Weighting x Score)
Total weighting percentage of this Appraisal
Top 10 Critical Tasks/Goals set in 2022 REMARKS: Factor B.2 shall be 50%, whatever number of
tasks listed shall be manually summed 50%

Target of Actual of
No Tasks/Goals Description %
Accomplishment (date) Accomplishment (date)

Completed P1 (Perpanjangan izin penggunaan sisa bahan

1 29-Nov-23 29-Nov-23 8% 3 0.0
Peledak)

Completed P3 (Pemilikan, Penguasaan dan Penyimpanan Bahan

2 15-Mar-23 15-Mar-23 8% 3 0.0
peledak) and warehouse explosive Permit

3 Finishing DPM FS Document Desember 2023 Continue 8% 2 0.0

4 8% 0.0

5 5 7% 0.0

6 6 6% 0.0

7 7 5% 0.0

0.0

0.0

TOTAL SCORE - B.2 Critical Tasks Achievement 50% 0.0

SCORE Critical Task Achievement

Completed task in time (before targeted due date) with very good quality
4 work result as per required standard Total Score - B.1 Supervisory-Managerial Skills 0.0

Completed task on time (as targeted due date) with very good quality work
3 result as per required standard Total Score - B.2 Critical Tasks Achievement 0.0

Completed task on time (as targeted due date) with some improvements
2 required on quality work result Cumulative Total Score - B Supervisory-Managerial Skills +Critical Tasks Achievement 0.0
Completed task out time (late from targeted due date) with some
1 improvements required on quality work result

0 Task not done

Proposed training & development for Employee to support further achievement

Software Training For UG Mine And POM Training

Manager's comments on Employee's overall performance, behavior and achievement

FINAL SCORE
Total Score Weight RATING
(A×40%)+(B×60%)
Total Score A 0.0 40%
Cumulative Total Score B 0.0 60%
0.0 D

Employee, Appraiser, GM/VP, A 3.6 - 4.0

B 2.6 - 3.5
C 1.6 - 2.5
D 0 - 1.5

(…………………………………) (…………………………………) (…………………………………)