"Performance Evaluation Form" - City of Richmond, Virginia

Performance Evaluation Form is a legal document that was released by the Department of Human Resources - City of Richmond, Virginia - a government authority operating within Virginia. The form may be used strictly within City of Richmond.

Form Details:

  • Released on January 1, 2000;
  • The latest edition currently provided by the Department of Human Resources - City of Richmond, Virginia;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Department of Human Resources - City of Richmond, Virginia.

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Download "Performance Evaluation Form" - City of Richmond, Virginia

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Evaluation Type
Probationary*
EMPLOYEE PERFORMANCE EVALUATION FORM
 Annual
Unclassified
Employee’s Name:
Employee Number:
Evaluation Date:
/
/
Last, First
mm/day/year
Position Title:
Department:
Division/Unit:
Read each Evaluation Factor and insert a Value based on the employee’s priority and job function during the evaluation period. Each Evaluation Factor must be
greater than zero. The total Value points of all Evaluation Factors must equal 100. Rate the employee’s performance during the evaluation period by placing the
appropriate number in the Rate column, based on the following scale: 4 = Exceptional, 3 = Exceeds Standards; 2 = Meets Standards; 1 = Below Standards. The Score
for each Evaluation Factor will be the Value multiplied by the Rate. The overall Performance Rating will be the sum of the Annual scores.
Interim
Annual
EVALUATION FACTOR
Value
Rate
Score
Rate
Score
Measures the employee’s level of understanding of their current position.
1.
Knowledge of the Job:
0
0
0
Measures the employee’s work against minimum criteria for determining if
2.
Work Product Quality:
0
0
meets the required quality standards; i.e., accuracy, neatness, completeness, and productivity.
Measures the employee’s ability to creatively and effectively solve or prevent
3.
Problem Solving:
0
0
problems in the workplace with existing resources.
Measures the employee’s ability to work effectively as a team member when necessary.
4.
Teamwork:
0
0
5.
Responsibility:
Measures the employee willingness to be responsible for the outcome of assigned
0
0
tasks including the effective use of equipment, supplies and tools.
Measures the employee’s ability to adapt to new and changing situations in the workplace.
6.
Flexibility:
0
0
Measures the employee’s interaction and responsiveness in their dealings with
7.
Customer Service:
0
0
internal and external customers in the conducting of normal City business.
Measures the employee’s ability and
8.
Compliance with City policies and Legal Standards:
0
0
willingness to observe all written rules and procedures established by the City of Richmond.
Measures the employee’s ability to follow safety laws, rules and standard operating
9.
Safety:
0
0
procedures along with their commitment to a safe workplace.
This aspect measures the employee’s timely arrival at work, leave at the proper time,
10.
Attendance:
0
0
schedule meal breaks properly, and timely requests for leave to avoid unnecessary absences.
11.
Accomplishments:
Measures the employee accomplishment of tasks and goals including, but not
0
0
limited to those stated in the previous performance evaluation.
100 - 199
200 - 299
300 - 379
380 - 400
0
0
0
Performance
Rating Range
Not eligible for
Eligible for C level
Eligible for B level
Eligible for A level
Performance Rating
salary increase
salary increase
salary increase
salary increase
*For probationary employees the Salary Increase level will not exceed “Level C.”
Manager/Supervisor Performance Evaluation Form 2007 - 001 Rev. 00
Last printed 8/19/2015 1:05 PM
Page 1 of 2
Evaluation Type
Probationary*
EMPLOYEE PERFORMANCE EVALUATION FORM
 Annual
Unclassified
Employee’s Name:
Employee Number:
Evaluation Date:
/
/
Last, First
mm/day/year
Position Title:
Department:
Division/Unit:
Read each Evaluation Factor and insert a Value based on the employee’s priority and job function during the evaluation period. Each Evaluation Factor must be
greater than zero. The total Value points of all Evaluation Factors must equal 100. Rate the employee’s performance during the evaluation period by placing the
appropriate number in the Rate column, based on the following scale: 4 = Exceptional, 3 = Exceeds Standards; 2 = Meets Standards; 1 = Below Standards. The Score
for each Evaluation Factor will be the Value multiplied by the Rate. The overall Performance Rating will be the sum of the Annual scores.
Interim
Annual
EVALUATION FACTOR
Value
Rate
Score
Rate
Score
Measures the employee’s level of understanding of their current position.
1.
Knowledge of the Job:
0
0
0
Measures the employee’s work against minimum criteria for determining if
2.
Work Product Quality:
0
0
meets the required quality standards; i.e., accuracy, neatness, completeness, and productivity.
Measures the employee’s ability to creatively and effectively solve or prevent
3.
Problem Solving:
0
0
problems in the workplace with existing resources.
Measures the employee’s ability to work effectively as a team member when necessary.
4.
Teamwork:
0
0
5.
Responsibility:
Measures the employee willingness to be responsible for the outcome of assigned
0
0
tasks including the effective use of equipment, supplies and tools.
Measures the employee’s ability to adapt to new and changing situations in the workplace.
6.
Flexibility:
0
0
Measures the employee’s interaction and responsiveness in their dealings with
7.
Customer Service:
0
0
internal and external customers in the conducting of normal City business.
Measures the employee’s ability and
8.
Compliance with City policies and Legal Standards:
0
0
willingness to observe all written rules and procedures established by the City of Richmond.
Measures the employee’s ability to follow safety laws, rules and standard operating
9.
Safety:
0
0
procedures along with their commitment to a safe workplace.
This aspect measures the employee’s timely arrival at work, leave at the proper time,
10.
Attendance:
0
0
schedule meal breaks properly, and timely requests for leave to avoid unnecessary absences.
11.
Accomplishments:
Measures the employee accomplishment of tasks and goals including, but not
0
0
limited to those stated in the previous performance evaluation.
100 - 199
200 - 299
300 - 379
380 - 400
0
0
0
Performance
Rating Range
Not eligible for
Eligible for C level
Eligible for B level
Eligible for A level
Performance Rating
salary increase
salary increase
salary increase
salary increase
*For probationary employees the Salary Increase level will not exceed “Level C.”
Manager/Supervisor Performance Evaluation Form 2007 - 001 Rev. 00
Last printed 8/19/2015 1:05 PM
Page 1 of 2
EMPLOYEE PERFORMANCE EVALUATION FORM: Page 2 of 2
12. Identify examples of accomplishments that resulted in an overall Performance Rating of 380 - 400 (Additional sheets may be used).
a.
b.
c.
d.
13. Identify examples of actions that resulted in an overall Performance Rating Score of 100 - 199 (Additional sheets may be used).
a.
b.
c.
d.
14.
TRAINING AND DEVELOPMENT:
List proposed training and development plans for the employee (Additional sheets may be used).
a.
b.
c.
d.
List employee’s primary focus and expectations may include suggestions for improvement (Additional sheets may be used) .
PRIORITIES:
15.
a.
b.
c.
d.
Initial: 
Interim: 
Annual: 
16.
Performance Planning and Review:
Next Evaluation:
REQUIRED SIGNATURES:
To be completed at the end of the annual Performance Evaluation only.
Important Notes
Employee’s
signature
indicates
their
1. Supervisor’s Name:
Signature:
Date:
participation in the process and receipt of a
Print
copy. Employee’s comments may be submitted
as attachments.
2. Appointing Authority:
Signature:
Date:
Print
Performance
evaluation
ratings
are
not
considered
a
guarantee
of
continued
3. Employee’s Signature:
Date:
employment with the City of Richmond.
Page of 3