PT.

AQUAFARM NUSANTARA
PERFORMANCE APPRAISAL FORM
PENILAIAN PERFOMA KERJA

I PERSONAL PARTICULARS / Data Pribadi Point for Appraisal

Name / Nama : _____________________________ No Achievement Point

PR No. / Jenis Kelamin : _____________________________ 1 Excellent/ Memuaskan 10

Designation/ Jabatan : _____________________________ 2 Good / Baik 8

Dept / Section : _____________________________ 3 Satisfactory / Cukup 6

Join Date / Tgl Masuk : _____________________________ 4 Adequate / Kurang 4

End Contract/ Kontrak : _____________________________ 5 Poor / Buruk 2

Length service : _____________________________ HR Attendance Data Total day

Status : _____________________________ Leaves (AL) UPL

II PURPOSE OF APPRAISAL ASSESMENT ( Please tick with mark √ ) Sickness/ML MES

(…..) Probation Period / Masa Percobaan (…..) Promotion / Promosi Absent

(…..) Contract Renewal / Perpanjang Kontrak/ Permanent Employee (…..) Increment / Kenaikan Gaji Lateness

(…..) Transfer / Mutasi ( √ ) Annual Increment & Bonus / Kenaikan Gaji Tahunan & Bonus
III Period of service to appraise / Jangka waktu untuk penilaian :
01-Mar-18 to 28-Feb-19
IV GUIDELINES FOR APPRAISER ( Direct and or indirect Superior )
1. Aimed to measure about record of capability & accomplishment of the worker
Penilaian ini dimaksudkan untuk mengukur kemampuan & prestasi kerja karyawan
2. In filling this appraisal, the appraiser must be objective with his/her performance
Dalam memberikan penilaian, Penilai melakukan secara obyektif, sesuai daya hasil yang dicapai
Notes : Please return this form to HR Section before date :
Mohon kembalikan form ini ke HR sebelum tanggal

Please tick with mark ( √ ) in point column for achievement. If needed please fill in remarks column
Tandai ( √ ) pada kolom poin yang dicapai. Jika perlu tambahkan catatan pada kolom keterangan
Point
Description Remarks
10 8 6 4 2
A. PERFORMANCE & IMPROVEMENT
1. Quality of Works / Kualitas Kerja …………...……. %
Work & achieve a high quality work Filled by each Grp
95%< X ≤ 100% 90%< X ≤ 95% 85%< X ≤ 90% 80%< X ≤ 85% 75%< X ≤ 80%
Bekerja dengan standard kualitas kerja Sesuai Data Prodn
2. Output of Work / Hasil Kerja …………...……. %
Consistently to achieve work output Filled by each Grp
> 105% 100%< X ≤ 105% 95%< X ≤ 100% 90%< X ≤ 95% 85%< X ≤ 90%
Konsisten mendapat target produksi yg diberikan Sesuai Data Prodn
3. Job Knowledge / Pengetahuan & Kemampuan Berikan komentar
Has knowledge for each aspect of jobs
to complete job excellently & willing to learn
Memiliki pengetahuan untuk meyelesaikan
pekerjaan & berkemauan untuk belajar
4. Improvement / Perbaikan Hasil Kerja Berikan komentar
Ability to convey ideas to improve productivity
Mampu memberikan ide untuk memperbaiki
atau meningkatkan produktivitas

TOTAL POINT : ………. x 1.25 = …..….. ( Max 50 point )

Point
Description Remarks
10 8 6 4 2
B. DISCIPLINE & WORK ETHICS
1. Attendance / Kehadiran Kerja For Male Employee Total Attendance
Present consistently at the work place > 95% 91%< X ≤ 94% 87%< X ≤ 90% 83%< X ≤ 86% 79%< X ≤ 82% 100,00%

Selalu hadir/ bekerja teratur For Female Employee ( filled by HR )

> 91% 87%< X ≤ 90% 83%< X ≤ 86% 79%< X ≤ 82% 75%< X ≤ 78% Diisi oleh HR

Work PErformance Form Recruitment Develop

 Point
Description Remarks
10 8 6 4 2
2. Lateness / Keterlambatan masuk kerja Total Lateness
Punctuality in working time 0 times
Masuk kerja sesuai waktu yg telah ditetapkan ( filled by HR )
Zero Late 1-8 times 9-17 times 18-29 times more 30 times
Diisi oleh HR
3. Written Disciplinary Action Discussion/ Warning
Violate of dicipline or working standard Letter
Melakukan pelanggaran terhadap displin atau more 3rd
Good discpline 1st Warning 2nd Warning 3rd Warning
standar pekerjaan Warning ( filled by HR )
4. Care of company resources/ Safe Act Number of
Care of material, product ,tools,equipments etc. cases
Memakai dan menjaga barang milik perusahaan ………………
Zero 1 time 2 ~ 3 times 4 ~ 5 times more 5 times
tetap baik dan tidak rusak Filled by each Grp
5. Approved suggestion Number of
Take part in suggestion scheme and approved Approved suggestion
Memberikan saran untuk kemajuan perusahaan
more than 12 8-11 5-7 1-4 0
dan disetujui ( filled by HR )

TOTAL POINT : ………. x 1.00 = ……….. ( Max 50 point )

TOTAL SCORE = ( A + B ) / 100 = …….………….……. %

OVERALL ASSESSMENT ( Put a tick √ in the appropriate box )

A > 85 % Excellent / Sangat Memuaskan D 50 % - < 60 % Fair / Kurang

B 71 % - 85 % Good / Baik E < 50 % Poor / Kurang sekali

C 60 % - < 71 % Adequate / Cukup

Date & Signature / Tanggal & Tanda tangan

Employee : Apraised By Respective Superior Approved By : Department Head

Name : Name : Name :

Employee's comments / Pendapat dari Karyawan

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

……………………………………………………………………………………………………………………………
Summary by Supervisor/ Rangkuman oleh Spv

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

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

Recommendation Manager / Rekomendasi oleh Manager : …………………………………………………………………………………………………………

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

Recommendation Result : END CONTRACT / PERMANENT / TRANSFER / PROMOTION / INCREMENT

Level of asessment
Level Appraised by Acknowledgement by Approved by
Operator / Inspector / Setupman Team Leader Supervisor / Snr Staff Department Head
Clerk/ Asst Leader / Leader / Supervisor Manager Department Head
Staff / Supervisor/ Manager Manager Department Head
Asst Manager Department Head General Manager
Department Head General Manager

Work PErformance Form Recruitment Develop