QRX Digital Self-evaluation Performance Appraisal

Form
Please complete this self-evaluation form prior to your formal performance appraisal. This form is a reflection of your acoomplishments and
is a usefeul tool. it informs your immediate supervisor of what you do, how you spend your time, as well as better understand how you view
yourself and your acoomplishments. This form will be considered as part of the performance appraisal process.

Staff's Name: Position

Supervisor's Name: Department
Review Period: Date:

Reason for review: Promotion Unsatisfactory Performance

✘ Quarterly Appraisal

Instructions: Rate the your performance during the review period by checking the most appropriate numerical value in each section. To
determine your overall performance rating, add the numerical values together and divide by eight.

Rating scale:
5 Outstanding (consistently exceeds standards)
4 Very Satisfactory (frequently exceeds standards)
3 Satisfactory (generally meets standards)
2 Unsatisfactory (frequently fails to meet standards)
1 Poor (fails to meet standards)

Focus Area 5 4 3 2 1

Job knowledge
Knowledge of products, policies and procedures; OR knowledge of
techniques, skills, equipment, procedures, and materials.

Comments:

Quality of work
Freedom from errors and mistakes. Accuracy, quality of work in
general.

Comments:

Quantity of work
Productivity of the Staff.

Comments:

Reliability
The extent to which the Staff can be depended upon to be available for
work, to complete work properly, and complete work on time. The
degree to which the Staff is reliable, trustworthy, and persistent.

Comments:

Initiative and creativity

The ability to plan work and to proceed with a task without being told
every detail and the ability to make constructive suggestions.
Comments:

Judgment
The extent to which the Staff makes decisions that are sound. The
ability to base decisions on fact rather than emotion.

Comments:

Cooperation
Willingness to work harmoniously with others in getting a job done.
Readiness to respond positively to instructions and procedures.

Comments:

Attendance
Consistency in coming to work daily and conforming to scheduled work
hours.

Comments:

Adaptability/Resourcefulness
The ability to adjust to change with a minimum of disruption to
productivity. The knowledge and willingness to observe proper use of
resources established by the company.

Comments:

Complete this section for Staff with supervisory responsibilities:

5 4 3 2 1
Planning and organizing
The ability to analyze work, set goals, develop plans of action, utilize
time. Consider amount of supervision required and extent to which you
can trust employee to carry out assignments conscientiously."

Comments:
Directing and controlling
The ability to create a motivating climate, achieve teamwork, train and
develop, measure work in progress, take corrective action.

Comments:
Decision-making
The ability to make decisions and the quality and timeliness of those
decisions.

Noteworthy accomplishments during this review period:

Areas requiring improvement in job performance:

Actions to take to improve performance:

Add all numerical values from each category then divide by 9.

Overall Performance Rating:
5 Outstanding
4.0-4.99 Very Satisfactory
3.0-3.99 Satisfactory
2.0-2.99 Unsatisfactory
1.0-1.99 Poor

Outstanding: Delivers extraordinary accomplishments in their role asa measured by results, consistent work quality, quantity and
timeliness in all areas of responsibility. His or her contributions have made an outstanding impact on the achievement of
department priorities.
Very Satisfactory: Exceeds established expectations as measured by results, consistent work quality, quantity and timeliness in
most areas of responsibility. He or she exhibits mastery in most dimensions of work performed, making a significant contribution
in support of department goals.
Satisfactory: Meets established expectations as measured by results, work quality, quantity and timeliness in areas of
responsibbility. He or she exhibits proficiency in most dimensions of the work performed, achieves and occasionally exceeds
established goals.
Unsatisfactory: Inconsistent in meeting most established expectations in terms of results, consistent, work quality, quantity and
timeliness in one or more important areas of responsibility, and/or one or more of of the most critical goals were not met.
Continued development and improvement is required in key areas of the job in order to successfully meet expectations.
Poor: Performance was consistently below expectations, and/or reasonable progress toward critical goals was not made.
Significant improvement is needed in one or more important areas.

Signatures to acknowledge that this form was discussed and reviewed.

Staff's Signature: Date:

Supervisor's Signature Date:

Manager's Signature Date: