C o m p an y Na m e

Numeri cal Scale Per f or m a nc e

Revie w Fo rm
Employee: Employee Title:
Super vis or: Per for man ce Pe riod:

A. C u r r e nt Goals a n d Respo nsib ilities

1. Des cribe t h e c urre nt p e r for ma n ce pe r iod ’s go a ls ; if applicable, make note of any
significant changes to the position description since last year’s performance review.

B. Perf or mance A s s e s s m e n t ( a t ta c h additi ona l s u p p o r t in g info rma tion a s n e e d )

1. Ask t h e em plo ye e t o compl e te a pe rfor ma n ce Se l f- As s e s s me nt, b a s e d o n t h e
C u rre n t Goa ls a n d R e spons ibilitie s ( s e e a bove ).

2. Provide your r e s p o ns e s to t h e Pe rfo rma n ce C om pe te n c i e s (Se c tion C be lo w ) t o

inform your a s s e s s m e n t .

3. Eva lua te a n d dis c us s t h e e mploye e ’s j ob pe rf or ma n ce a n d de v e lo pm e nt

a ch ie ve me n t. Base your evaluation upon the position requirements, achievement of the
goals established during the past year and your assessment of the employee’s
accomplishments.

4. Are t h e r e a r e a s of e xce ptiona l pe r fo rm a nce t h a t s h ould b e pa rticula rly n o t e d ?

Provide specific e x a mp l e s .

5. Are t h e r e a r e a s of p e rfor ma n c e ne e d i n g m o r e a t te n t i o n or im p ro v e m e n t? Provide

specific e x a m p le s .

6. I n w h a t w a y is t h e e mp lo ye e r e a d y for inc re a s e d re s pons ibility? W ha t a ddit iona l

tra in ing will h e / s h e n e e d t o be s ucce ss ful?

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C. Perf or man ce C o m p ete n c ie s

Depending on position, some competencies may be more relevant than others.
5 Exc ept ion a l: Performance is consistently superior and significantly exceed s position
requirements.
4 Highly Performance frequently exceed s position requirements.

ab e
Ef f ective:
3 P rof ic ient: Performance consistently meets position requirements.

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e t e
2 I n co n s is t e nt : Performance meets some, but not all position requirement s.

ns at s a to r
2 I n o n s s te n t

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x ep t on a
1 Unsat isf a ct or y : Performance consistently fails to meet minimum position requirements;

en t
employee lacks skills required or fails to utilize necessary skills.

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N /A N e w o r N ot Employee has not been in position long enough to have demonstrated the

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App licab le : essential elements of the position and will be reviewed at a later agreed upon

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5

3
4

1
date.
1. Skill and proficiency in carrying out
assignment’s Brief explanation:
2. Possesses skills and knowled ge to perform the job competently
Brief explanation:
3. Skill at planning, organizing and prioritizing workload
Brief explanation:
4. Hold s self- accountable for assigned responsibilities; sees tasks through to completion in a
timely manner
Brief explanation:
5. Prof iciency at improving work method s and procedures as a means toward greater efficiency
Brief explanation:
6. Communicates effectively with supervisor, peers, and customers
Brief explanation:
7. Ability to work independ ently
Brief explanation:
8. Ability to work cooperatively with supervision or as part of a team
Brief explanation:
9. Willingness to take on add itional responsibility’s
Brief explanation:
10. Relia bil ity (attendance, punctuality, meeting deadlines)
Brief explanation:
11. Ad eptnes s at analysing facts, problem solving, decision-making, and demonstrating good
judgment
Brief explanation:

Ad d it ion a l p e r f o r ma n c e c o mp et e n c ie s f or e mp l o y e e s w it h supe r v is or y r esp o ns ib ilit ie s

12. Displays fairness toward s all subord inates.

Brief explanation:
13. Identifies performance expectations, gives timely feed back and cond ucts f ormal
performance appraisals.
Brief explanation:
14. Helps employees to see the potential for developing their skills; assists them in eliminating
barriers to t heir d evelopment.
Brief explanation:
15. Delegates responsibility where appropriate, based on the employee’s abilit y and potential.
Brief explanation:
16. Takes timely and appropriate corrective/d isciplinary action with employees.
Brief explanation:
17. Takes specif ic steps to create and develop their d iverse workforce and to promote an
inclusive environment.
Brief explanation:

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D. Goa l Sett in g a n d De v e l op m ent Plann ing

1. List the employee’s performance goals for the coming year:

2. How do these align with departmental goals?

3. List the employee’s development goals for the coming year:

4. In the coming year, how will you provide guidance and assistance for the employee to
accomplish his/her goals?

E. Employe e C o m m e n t s ( O pti ona l)

The employee may comment on the performance review in the space provided below.

Please sign below to acknowledge that the employee has received this document.
Employee ’s Sign a t u re: D a te:
Supervi sor’s Si gn a ture: D a te:

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