"Non-exempt Staff Performance Evaluation Form"

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PERFORMANCE EVALUATION FORM
NON-EXEMPT STAFF
Date:
Employee Name/Title:
Location:
Date of Hire:
Date Hired Into Current Position:
Division/Department:
Supervisor/Title:
Review Period:
Annual (Period:
to
)
Other (Reason:
)
INSTRUCTIONS: This form will be completed by the employee’s immediate supervisor and reviewed by the next level supervisor. When completed
and signed, a copy is given to the employee, a copy is retained by the supervisor, and the original is sent to Human Resources. Supervisors should
check the most appropriate rating, make an explanatory comment to support your rating, and cite specific examples of performance leading to
Unsatisfactory, Needs Improvement, or Exceeds Expectations ratings. For Unsatisfactory performance, list specific goals for improvement and the date
you expect them to be achieved. In addition, review the current job description with employee and contact Human Resources if you believe any
changes are appropriate.
Supervisor’s Initials
Employee’s Initials
I. JOB DESCRIPTION REVIEWED
Date:
II. PERFORMANCE EVALUATION
Needs
Meets
Exceeds
PERFORMANCE FACTOR
Unsatisfactory
Comments
Improvement
Expectations
Expectations
Job Competencies:
Understands
and
demonstrates
competence in job requirements set
forth in the job description.
Productivity:
Produces
an
acceptable
amount
of
work,
organizes
and
prioritizes
work,
utilizes
time
well
and
meets
deadlines.
Quality:
Completes
work
accurately
and
neatly
to meet
quality standards.
Responsibility/Initiative:
Accepts, begins, follows through,
and fulfills work assignments and
training.
Relationships:
Establishes and
maintains
effective
relationships
with others with whom interaction is
required.
Adaptability/Resourcefulness:
Adjusts to change with a minimum
of
disruption
to
productivity.
Contributes
useful
ideas
for
improved performance.
Conduct:
Conforms to policies
and
procedures;
demonstrates
appropriate workplace behavior.
Training:
Completes
required
training In a timely manner.
Attendance/Punctuality:
Conforms to standards for
attendance and punctuality.
Unplanned Absences in this review period:
days;
occurrences;
percentage of scheduled hours/shifts.
Lateness in this review period:
occurrences.
OVERALL EVALUATION
Unsatisfactory
Needs Improvement
Meets Expectations
Exceeds Expectations
Supervisor’s Signature_________________________ ___ Next Level Supervisor’s Signature _________________________________
Employee’s Signature____________________________________________
PERFORMANCE EVALUATION FORM
NON-EXEMPT STAFF
Date:
Employee Name/Title:
Location:
Date of Hire:
Date Hired Into Current Position:
Division/Department:
Supervisor/Title:
Review Period:
Annual (Period:
to
)
Other (Reason:
)
INSTRUCTIONS: This form will be completed by the employee’s immediate supervisor and reviewed by the next level supervisor. When completed
and signed, a copy is given to the employee, a copy is retained by the supervisor, and the original is sent to Human Resources. Supervisors should
check the most appropriate rating, make an explanatory comment to support your rating, and cite specific examples of performance leading to
Unsatisfactory, Needs Improvement, or Exceeds Expectations ratings. For Unsatisfactory performance, list specific goals for improvement and the date
you expect them to be achieved. In addition, review the current job description with employee and contact Human Resources if you believe any
changes are appropriate.
Supervisor’s Initials
Employee’s Initials
I. JOB DESCRIPTION REVIEWED
Date:
II. PERFORMANCE EVALUATION
Needs
Meets
Exceeds
PERFORMANCE FACTOR
Unsatisfactory
Comments
Improvement
Expectations
Expectations
Job Competencies:
Understands
and
demonstrates
competence in job requirements set
forth in the job description.
Productivity:
Produces
an
acceptable
amount
of
work,
organizes
and
prioritizes
work,
utilizes
time
well
and
meets
deadlines.
Quality:
Completes
work
accurately
and
neatly
to meet
quality standards.
Responsibility/Initiative:
Accepts, begins, follows through,
and fulfills work assignments and
training.
Relationships:
Establishes and
maintains
effective
relationships
with others with whom interaction is
required.
Adaptability/Resourcefulness:
Adjusts to change with a minimum
of
disruption
to
productivity.
Contributes
useful
ideas
for
improved performance.
Conduct:
Conforms to policies
and
procedures;
demonstrates
appropriate workplace behavior.
Training:
Completes
required
training In a timely manner.
Attendance/Punctuality:
Conforms to standards for
attendance and punctuality.
Unplanned Absences in this review period:
days;
occurrences;
percentage of scheduled hours/shifts.
Lateness in this review period:
occurrences.
OVERALL EVALUATION
Unsatisfactory
Needs Improvement
Meets Expectations
Exceeds Expectations
Supervisor’s Signature_________________________ ___ Next Level Supervisor’s Signature _________________________________
Employee’s Signature____________________________________________
2
)
PERFORMANCE EVALUATION (Employee:
DATE:
EVALUATION PERIOD:
TO
III. Performance Narrative and Comments by Immediate Supervisor (include a summary of and rationale for your overall evaluation, as well as the
status of performance objectives, strengths and developmental needs and measurable objectives for next evaluation period):
Please note:
(a) Status of performance objectives during the review period
(b) key strengths and developmental needs of employee
(c) measurable objectives for next review period
Supervisor’s Signature:
Date:
l
IV. Comments by Next Level Supervisor (Comment on the employee’s performance from your perspective. Add extra sheets if necessary.)
Next Level Supervisor’s Signature:
Date:
l
V. Comments by Employee. My performance has been discussed with me as described in this evaluation, I have received a copy of this evaluation,
and my evaluator and I have reviewed my current job description. (Add any comments you have about your performance, development, or evaluation.
If you wish, you may give these comments directly to your supervisor in writing within the next three [3] working days. Add extra sheets as necessary.)
Employee’s Signature:
Date:
l
3
Instructions for Performance Evaluation Form for Non-Exempt Employees
This form is used for annual or performance improvement plan evaluations for non-exempt (hourly) employees. If you have any
question about whether this is the correct for use, please contact the Human Resources Department.
The form has areas to be completed by the evaluator to identify the employee being evaluated, the evaluator and the dates of the
evaluation period. This information is to be entered at the top of both pages of the evaluation form in the spaces provided.
The evaluation itself it contained in five sections identified with Roman numerals I through V.
I. Job Description Review – The evaluator reviews the job description of the employee being evaluated and confirms its accuracy or
notes any proposed changes. For unique job descriptions (that is, when there is only one incumbent with that title), changes may be
appropriate if duties, responsibilities, supervision details or qualifications change. It is less likely that changes will be appropriate in job
descriptions in which there are multiple incumbents with the same title. Typically, not all employees with the same job title routinely
perform all the duties or responsibilities appropriate for the group as a whole. Changes in job descriptions for positions with multiple
incumbents should only be recommended if the job description as a whole no longer applies to the employee being evaluated or if the
change is applicable to all of the incumbents. Please note any proposed changes and alert the Department of Human Resources which
must approve all changes. Both the evaluating supervisor and the employee should initial that they have review the job description and
enter the date on which this review was conducted. In the case of a change in the job description that is approved by Human
Resources, the supervisor should meet again with the employee, confirm the change and provide the employee with a copy of the
revised job description.
II. Performance Evaluation – The evaluator rates the employee’s performance in each of the performance factors listed and puts a
check mark or X in the column best describing the performance.
Unsatisfactory – Performance regularly falls substantially below the requirements of the job. The evaluator must include comments
describing the unsatisfactory performance and establish measurable goals and timetable for improvement in Section III.
Needs Improvement – Performance regularly falls below or occasionally falls substantially below the requirements of the job. The
evaluator must include comments describing the unsatisfactory performance and establish measurable goals and timetable for
improvement in Section III.
Meets Expectations – Performance regularly meets the requirements of the job, with few cases of performance that is unsatisfactory or
that needs improvement. Performance may occasionally exceed the requirements of the job.
Exceeds Expectations -- Performance regularly exceeds the requirements of the job. The evaluator must include comments describing
the performance in measurable terms.
Unplanned absences and lateness should be entered on the form and discussed with the employee. Unplanned absences exceeding
the maximum acceptable limit described in BAMSI’s Attendance Policy should be addressed as described in the policy.
Finally, the evaluator uses a check mark or X to evaluate the employee’s overall performance, based on and consistent with the
individual performance factor evaluations and supported by the evaluator’s comments and entries in Section III. Supervisors must
create a Performance Improvement Plan with measurable performance goals and timetables for employees with an overall evaluation
of Unsatisfactory or Needs Improvement. Employees with an overall evaluation of Unsatisfactory must be evaluated again in three (3)
months and may be subject to dismissal if there is not measurably significant and sustained improvement and progress at that time.
Employees who are evaluated as Needs Improvement for two (2) consecutive evaluation periods must be evaluated again in three (3)
months and may be subject to dismissal if there is not measurably significant and sustained improvement and progress at that time.
Documented monthly progress meetings between the employee and the evaluator must be held in all cases for employees on
Performance Improvement Plans.
III. Performance Narrative and Comments by Immediate Supervisor -- The evaluator must provide a rationale for the employee’s
overall performance evaluation as well as the status of performance objectives, strengths and developmental needs and measurable
objectives for next evaluation period. Detail must support evaluations of Unsatisfactory, Needs Improvement or Exceeds Expectations.
IV. Comments by Next Level Supervisor – The supervisor of the evaluator completes, signs and dates this portion of the evaluation
BEFORE it is reviewed with the employees. This demonstrates the next level supervisor has reviewed the evaluation and agrees with
the comments and conclusions.
V. Comments by Employee – The employee signs and dates the evaluation to acknowledge that it has been discussed with the
employee, that the employee has been provided a copy of the evaluation and that the employee and the evaluator have reviewed the
employee’s job description. The employee’s signature and date are required and do not necessarily signify that the employee
agrees with the evaluation. Employees may provide their own comments on the evaluation form, or submit additional comments
within three (3) days of the evaluation, or on their next day of scheduled work if it not within the three-day period. Employee comments
will be attached to the evaluation and maintained with it in the employee’s personnel file.
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