Employee Performance Appraisal Form

Employee Information
Employee ID No: _________________ Date: ____________

Last Name: _______________ First Name: _______________

Position Held: __________________ Department _______________

Appraiser‘s Information

Last Name: _______________________ First Name: _______________

Position Held: __________________________________________________

Appraisal Period: From Date: _________________To Date: __________________

Reason for Appraisal: Annual review/ Probationary review/Change in role/ position

INSTRUCTIONS: This performance appraisal form must be completed by the immediate

supervisor having discussed with the respective staff based on established performance standards.
Always consider dialogue from both parties and demonstrated performance results and behaviours.

The appraisal form must be filled in at the appraisal due date and returned to HR Office by the 14th
day thereafter. As a necessity, Key performance Objectives (KPOs), a Performance Improvement
Plan (PIP) and a 3600 assessment tool shall be used on top of this main performance assessment
form to compliment the fairness of the results.

Description of Rating Rating

Exceeds Expectations
Extraordinary and exceptional accomplishments 5

Achieves Expectations
Proficiently capable/accomplished 4

Meets Expectations/Competent
Fully accomplished all major position requirements 3
Minor deviations from expectations

Marginal/Needs Improvement
Meets some important position requirements 2
Some deviations leave room for improvement

Unsatisfactory
Not achieving position requirements 1
Several areas in which improvement is needed
Performance Feedback: Please tick () or shade the box as appropriate (using the rating
factors/ scale described above and illustrated below).
Exceeds Achieves Meets expectations/ Marginal/Needs Unsatisfactory
expectations Expectations Competent improvement
5 4 3 2 1
Summary of
Main Activities
Summary of Main (for Activities
the for the appraisal period (from……………. to………….. ):
appraisal Results of the last period from the Main Activities (results
Refer to Key Performance
period):
attained), agreed KPO’s (as appears on Objective Setting Form), and Projects/Special
Activities (as agreed with Appraiser).
Key Performance
Objectives
(KPOs)
A. Performance of Main Activities
Agreed KPO’s of
Quality (as showntheinlast
theperiod
relevance of work results) 5 4 3 2 1
(as appears on
Quantity (as shown in the amount of results within specified time) 5 4 3 2 1
Objective
Summary (qualitative
Settingdescription)
Form): of Appraiser’s comments:

______________________________________________________________
Projects/Special
Activities (as
B. Performance on Agreed Objectives
agreed with
Appraiser):
Quality (as shown in the relevance of work results) 5 4 3 2 1
Quantity (as shown in the amount of results within specified time) 5 4 3 2 1
Summary (qualitative description) of Appraiser’s comments:

______________________________________________________________

C. Performance on Special Projects (if applicable)

Quality (as shown in the relevance of work results) 5 4 3 2 1

Quantity (as shown in the amount of results within specified time) 5 4 3 2 1

Summary (qualitative description) of Appraiser’s comments:

______________________________________________________________

D. Performance feedback on CoRSU core values (i.e. applying CoRSU’s values)

1. Patient Focus: 5 4 3 2 1
As shown in how effectively someone serves Patient’s needs as well as internal and/ or
external clients to improve quality of life of patients and their families
2. Integrated team work:
5 4 3 2 1
As shown in how clearly works together with others to harness a share vision and
mission in their daily work.

3. Respect and Courtesy: 5 4 3 2 1

As reflected in embracing diversity; empowering people and treating others with empathy
and respect.

4. Open Communication: 5 4 3 2 1
Expressing and exchanging ideas freely to learn, grow and improve service delivery.

5. Transparency and Accountability: 5 4 3 2 1

As reflected in how someone shares accurate information and being accountable

(effectively & efficiently managing organizational resources)

6. Creativity and Innovation: 5 4 3 2 1

As reflected in generating and adopting new ways to improve the quality of service

Summary (qualitative description) of Appraiser’s comments:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

E. Performance Behaviour

Ability to Organize and Direct (in thinking and action) 5 4 3 2 1

As shown in how someone implements using reflective, structured & forward thinking.

Determined and Diligent in tasks/activities 5 4 3 2 1

As shown in how someone sees tasks through to completion

Adapting to change and flexibility 5 4 3 2 1

As shown in how well someone responds and adapts themselves to new situations

Imitative 5 4 3 2 1
As shown in how someone sees and acts upon opportunities and independently contributes
ideas

Planning and Objective Setting 5 4 3 2 1

As shown in the ability to set smart goals and work plans

Accountability 5 4 3 2 1

As shown in willingness to be held accountable for one’s actions and the actions of one’s
department/unit

Summary (qualitative description) of Appraiser’s comments:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

F. Professional competence; willingness to learn and share

Professional knowledge& technical expertise

5 4 3 2 1
As shown in the depths and breadth of job specific knowledge and how their efforts fit
into CoRSU’s systems

Willingness to learn, grow & implement new knowledge 5 4 3 2 1

As shown in readiness to improve update knowledge

Ability to take on new tasks/activities 5 4 3 2 1

As shown in the ability to take additional responsibilities

Innovative 5 4 3 2 1

As shown in the ability to integrate new ideas into established work systems

Summary (qualitative description) of Appraiser’s comments:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

G. Communication and Cooperation

Listening Skills 5 4 3 2 1

As shown in the ability to communicate clearly and to be understood

5 4 3 2 1
Verbal Expression
Ability to communicate clearly & express ideas appropriately

Team behaviour, participation in group tasks 5 4 3 2 1

As shown in the ability & willingness to express & explain ideas, information, knowledge
and experiences

Sharing of knowledge and information 5 4 3 2 1

As shown in the ability & willingness to express and explain ideas, information, knowledge
and experiences

Ability to handle conflict and criticism 5 4 3 2 1

As shown in coping with conflict and developing alternative approaches to problem

solving

Summary (qualitative description) of Appraiser’s comments:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

H. Management Qualities (i.e. For Employees in leadership positions):

Delegation responsibilities 5 4 3 2 1

As shown in the ability to break down work packages and delegate according to
employee’s abilities, following up and assisting where necessary

Supporting and developing employees 5 4 3 2 1

As shown generating measures of optimizing individual strengths and addressing
weak performance weaknesses of employees

Ensuring effective objective setting with employees 5 4 3 2 1

As shown in the ability to develop SMART Goals
5 4 3 2 1
Performance feedback

As demonstrated by open, honest and respectful performance feedback identifying

employee’s strengths and weaknesses

Accountability 5 4 3 2 1

As shown in willingness to be held accountable for one’s actions and the actions of one’s

department
Leadership Qualities 5 4 3 2 1
As shown in the ability to direct activities, operations and performance of others without
conflicting.

I. Summary: (Qualitative description) of Appraiser’s comments:

Fill-in seperately attached Appendix for setting Key Performance Objectives (KPO).

Performance Summary Description

Strengths

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Areas for improvement

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Support and Development

____________________________________________________________________

____________________________________________________________________

Ideas/agreements regarding professional and personal development plans (seminars and

other development measures)

____________________________________________________________________

____________________________________________________________________

Signature of Appraiser_______________ Date _________

Employee Comments

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

I have been informed about the above contents/performance feedback:

Signature of Employee _______________ Date __________

Second-Level Appraiser comments/Approval:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Name: ______________ Title ____________________ Sign __________

Third-Level Appraiser comments/Approval:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Name: ______________ Title ____________________ Sign __________

Key Performance Objectives (KPO) Form
Agreed Objectives for the next appraisal period: From………………… To …………………..

Name of employee: Position:

Name of Appraiser: Department:

No Objectives Tasks Resources/Conditions Cooperate Timeframe Status

(S.M.A.R.T.)1 with
1

Training Requirements

Training Purpose Essential Duration Location Cost Approval

1

We have discussed the above and mutually agree to the content

Signature of Employee Date Signature of Appraiser Date

1
S.M.A.R.T.  S = Specific, M=Measurable, A=Achievable, R=Result driven, T=Time bound
Employee Performance Improvement Plan
CoRSU EMPLOYEE PERFORMANCE IMPROVEMENT PLAN FORM (see guidelines on the
last page)
Employee name
Employee position and level
Supervisor’s name
Supervisor’s position
Date of plan
Period of plan (Typically 6 – 9 weeks)
Interim review date
Final review date

Performance improvement objective 1:

 Improve on ……………………………………………………………………………
 …………………..
Required outcomes  …………………………
 ………………………………..
 …………………….
Strategies  ……………………………
 ………………………………………
Performance improvement objective 2:
 Improve ……………………………………………….
 ……………………..
Required outcomes  ……………………
 …………………….
 ……………………….
Strategies  …………………………..
 ………………………………….
Performance improvement objective 3:
 Improve …………………………………………
 ……………………
Required outcomes  ……………………….
 …………………….
 ………………………..
Strategies  ………………………..
 ……………………….
Performance improvement objective 4:
 Improve ………………………………….
 ………………….
Required outcomes  …………………….
 …………….
 ……………………………
Strategies  ………………………….
 ……………………………..
Supports  ……………………………...
 ……………………………………
Employee:
Responsibilities  …………………………..
 ……………………………..
Supervisor:
 ……………………………..
 ………………………………..
Consequences
If the employee doesn’t meet the required
outcomes by the final review date, then
he/she will be terminated/not be
confirmed in the job.

Supervisor’s signature: …………………………………………

Print name: …………………………………. Date: ………………………………………

Employee signature: ………………………………………

Print name: …………………………………………… Date: ………………………

Employee self-assessment (Comments)

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………
CoRSU 3600 Anonymous Appraisal Tool
Dear Colleague,

You have been asked to assess performance of your colleague/supervisor to help with the
appraisal process. Kindly answer the following questions and hand in your response in a
sealed envelope and return it to the respective supervisor or the requestor for the
assessment. All replies are anonymous and confidential.

Note: Please use the following rating scale to answer the following questions. Mark
each question with the number that you think represents the individual’s
performance most accurately.

4: Exceeds 3: Meets 2: Partially Meets 1: Below

Expectations Expectations Expectations Expectation

Reviewer’s Job Title: e.g. Doctor /Nurse

Date:
/Other staff /professional, etc.
Describe how frequently you work with
Daily Very Frequently
(Dr/Mr/Mrs/Miss).
Sometimes Rarely
………………………………………

Aspect rating 1 2 3 4

Approachable - listens and is understanding

Respectful

Supportive of other staff

Has a professional attitude towards colleagues, patients and attendants

Reliable - you can trust him/her to carry out a task and give feedback to
key stakeholders

Reliability as a …………………………………….… (Please mention profession/role

title)

Other Ratings

Professional Skills

Knowledge

Communication skills and relationships with patients

Ability to deal with difficult situations

Response to calls for assistance/patient needs

Willingness to receive feedback and respond accordingly

Willingness to give feedback and respond accordingly

Flexibility and willingness to go the extra mile; responsiveness to calls

or request for support/advice

Time management

Personal development and continuous learning and improvement

Your Comments on:

Patient care

Integration with
colleagues and teams

Respect and Courtesy

(Embracing diversity)

Communication

Transparency and
accountability

Generating and adopting

to new ways/change

What I value about him/her:

What I think he/she needs to improve upon:

Any other comments

Official appraiser notes:

Total scores=…………/64 (quantitative score X16) based on rating.