"Performance Evaluation Form" - City and County of Broomfield, Colorado Download Pdf
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"Performance Evaluation Form" - City and County of Broomfield, Colorado

Performance Evaluation Form is a legal document that was released by the Performance and Internal Audit Department - City and County of Broomfield, Colorado - a government authority operating within Colorado. The form may be used strictly within City and County of Broomfield.

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  • Released on January 31, 2003;
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Performance Evaluation Page 1
PERFORMANCE EVALUATION
 ANNUAL
 INTERIM
Employee's Name:
Job Title:
Department:
Division:
Evaluation Period:
From:
To:
Date of Last Evaluation:
Date of Hire:
# of years in current position:
Supervisor:
Job Title:
INSTRUCTIONS
This form is designed to facilitate the performance evaluation of _____________ Department employees. In preparing for performance evaluation, the
supervisor should review the employee's position description, the employee's previous performance evaluation form, the employee's actual performance on
the job for the rating period, performance logs (if applicable) and then evaluate the employee's performance by completing this form. The employee is
encouraged to prepare a self-appraisal form to discuss with the supervisor at the performance evaluation interview. The performance evaluation interview is
a one-on-one conversation held between the supervisor and employee in order to openly discuss the employee's performance. The supervisor and
employee should also work together to set goals for the upcoming performance evaluation period including a discussion of training/development areas, job
objectives and special projects. A final performance evaluation is prepared and signed by the employee, the supervisor, the second-level supervisor (if
applicable) and the department head. The original performance evaluation form is filed in the employee's personnel file.
ACCOMPLISHMENT OF MAJOR WORK OBJECTIVES
In this section, record in priority order, major work objectives set in last year's performance evaluation session. If there were additional objectives and/or any
changes to agreed upon objectives throughout the year, be sure to record all such additions and the most recent revisions. Record specific results achieved
against those objectives. If this section does not apply, write "N/A.”
OBJECTIVES
RESULTS
1.
1.
2.
2.
3.
3.
4.
4.
PERFORMANCE FACTORS
In this section, assess each performance factor and circle the numerical value that best describes the employee's level of performance. If a particular
performance factor does not apply, write "N/A.” The supervisor is encouraged to use the "Comments" section for significant comments descriptive of the
employee's performance. This includes specific examples related to the employee's performance including guidance for further development. Ratings of a
"1" or a "5" MUST be justified in the "Comments" section. Descriptions of performance ratings are included with each performance factor. The supervisor
and employee should also keep the following general guidelines in mind when assessing performance. These guidelines are especially useful when
determining the rating for the employee in the 1 to 2 range or the 4 to 5 range.
5
Consistently outstanding performance, which exceeds stated objectives and/or goals.
Consistently seeks greater responsibilities; makes
suggestions; takes initiative to improve process/program; carries out duties in an exceptional manner; independent; demonstrates exceptional skills
level. Employee contributes to the performance of the division or department in a significant manner.
4
Consistently superior performance, which sometimes exceeds stated objectives and/or goals. Assumes more responsibility and performs above
standards with minimal supervision.
3
Consistently strong performance. Responsibilities are met in a wholly satisfactory manner. Normal guidance and supervision are required.
2
Consistently marginal performance. Employee sometimes performs at acceptable levels but lacks consistency. Rarely exceeds and often falls
short of desired results. Direction, supervision and training are required if objectives, duties and performance factors are to be met.
1
Consistently unacceptable performance. Inconsistent and ineffective performance. Work is not contributing to the division's goals; individual goals
and duties are not being achieved on a regular basis; performance results are not acceptable.
Performance Evaluation Page 1
PERFORMANCE EVALUATION
 ANNUAL
 INTERIM
Employee's Name:
Job Title:
Department:
Division:
Evaluation Period:
From:
To:
Date of Last Evaluation:
Date of Hire:
# of years in current position:
Supervisor:
Job Title:
INSTRUCTIONS
This form is designed to facilitate the performance evaluation of _____________ Department employees. In preparing for performance evaluation, the
supervisor should review the employee's position description, the employee's previous performance evaluation form, the employee's actual performance on
the job for the rating period, performance logs (if applicable) and then evaluate the employee's performance by completing this form. The employee is
encouraged to prepare a self-appraisal form to discuss with the supervisor at the performance evaluation interview. The performance evaluation interview is
a one-on-one conversation held between the supervisor and employee in order to openly discuss the employee's performance. The supervisor and
employee should also work together to set goals for the upcoming performance evaluation period including a discussion of training/development areas, job
objectives and special projects. A final performance evaluation is prepared and signed by the employee, the supervisor, the second-level supervisor (if
applicable) and the department head. The original performance evaluation form is filed in the employee's personnel file.
ACCOMPLISHMENT OF MAJOR WORK OBJECTIVES
In this section, record in priority order, major work objectives set in last year's performance evaluation session. If there were additional objectives and/or any
changes to agreed upon objectives throughout the year, be sure to record all such additions and the most recent revisions. Record specific results achieved
against those objectives. If this section does not apply, write "N/A.”
OBJECTIVES
RESULTS
1.
1.
2.
2.
3.
3.
4.
4.
PERFORMANCE FACTORS
In this section, assess each performance factor and circle the numerical value that best describes the employee's level of performance. If a particular
performance factor does not apply, write "N/A.” The supervisor is encouraged to use the "Comments" section for significant comments descriptive of the
employee's performance. This includes specific examples related to the employee's performance including guidance for further development. Ratings of a
"1" or a "5" MUST be justified in the "Comments" section. Descriptions of performance ratings are included with each performance factor. The supervisor
and employee should also keep the following general guidelines in mind when assessing performance. These guidelines are especially useful when
determining the rating for the employee in the 1 to 2 range or the 4 to 5 range.
5
Consistently outstanding performance, which exceeds stated objectives and/or goals.
Consistently seeks greater responsibilities; makes
suggestions; takes initiative to improve process/program; carries out duties in an exceptional manner; independent; demonstrates exceptional skills
level. Employee contributes to the performance of the division or department in a significant manner.
4
Consistently superior performance, which sometimes exceeds stated objectives and/or goals. Assumes more responsibility and performs above
standards with minimal supervision.
3
Consistently strong performance. Responsibilities are met in a wholly satisfactory manner. Normal guidance and supervision are required.
2
Consistently marginal performance. Employee sometimes performs at acceptable levels but lacks consistency. Rarely exceeds and often falls
short of desired results. Direction, supervision and training are required if objectives, duties and performance factors are to be met.
1
Consistently unacceptable performance. Inconsistent and ineffective performance. Work is not contributing to the division's goals; individual goals
and duties are not being achieved on a regular basis; performance results are not acceptable.
Performance Evaluation Page 2
MISSION STATEMENT – CITY AND COUNTY OF BROOMFIELD
Working in partnership with the community, the City and County of Broomfield provides
excellent services in an efficient, respectful, and courteous manner
to enhance and protect the environment and quality of life of Broomfield citizens.
GUIDING VALUES
We are here to serve our citizens as advocates and problem solvers.
We always treat our citizens and employees with dignity, respect, and equity.
We are fiscally responsible.
We are here to help Broomfield be a safe and enjoyable community filled with opportunity for citizens and
employees.
We care and we show it through our positive manner.
We respond quickly and we follow-up.
We value vision, diversity and progressive thinking.
We encourage new ideas and suggestions.
We maximize opportunities to advance the interests of the community as a whole.
Performance Evaluation Page 3
Job Knowledge/Technical Expertise: Incumbent must demonstrate understanding and effective utilization of job related information, technical skills and
procedures. Additional considerations are awareness of technical aspects of jobs; possessions of professional and administrative skills; be technically
competent; be knowledgeable about strategic direction of Department; and understand the City's culture.
1
2
3
4
5
Continually needs instructions; inadequate understanding of job
Generally well informed on primary job duties and responsibilities.
Exceptional technical understanding of all job functions.
fundamentals. Lacks technical expertise.
Demonstrates adequate technical expertise to perform job
Understands intricacies of job better than most employees.
functions.
Rating: Comments:
Punctuality/Attendance: Incumbent must demonstrate reliability in reporting to duty on time and on a consistent basis. Considerations include arriving and
departing according to schedule, and consistent attendance.
1
2
3
4
5
Unreliable; negative impact on operation. Late to work, takes
Generally prompt for work; regular in attendance. Careful to
Regular and prompt; strictly follows leave policy. Does not
extended breaks and/or lunch. Often absent without good reason
report back from lunch/break on time. If late, usually has a good
abuse lunch or break periods. Infrequently absent or tardy.
and/or frequently tardy.
reason.
Rating: Comments:
Work Ethic/Quantity/Productivity: Incumbent must demonstrate results regarding the amount of work produced in a workday. Consider the degree of
difficulty of employee's work responsibilities and other factors such as changes in schedules, interaction with other departments, the need to gather
information, etc. Consider output under normal conditions. Does employee utilize time effectively? Is he/she able to work on several assignments at the
same time?
1
2
3
4
5
Volume of work is not satisfactory to keep department running
Amount of work completed is satisfactory. Able to keep up with
Consistently completes more work than is required. Asks for
properly. Does just enough to get by. Does not utilize time
work and meet deadlines most of the time.
more work and strives to improve productivity.
efficiently.
Rating:
Comments:
Quality of Work: Incumbent is evaluated on the ability to get the job done with minimum supervision, caliber of work and the ability to maintain acceptable
results for quality control purposes. Considerations are acceptance of responsibility, being conscientious, and ability to meet accuracy and deadlines
requirements. Consider accuracy, neatness, thoroughness, attention to detail and other factors relating to quality. Is employee careful to avoid errors? Does
employee repeat mistakes, or learn from them?
1
2
3
4
5
Assignments not always carried through; requires close scrutiny to
Quality of work is generally careful and neat. Makes few errors.
Can be counted upon to complete assignments. Work
insure compliance. Work may be late, of poor quality, or not
Generally dependable. Can usually be relied upon to follow
produced is of consistently outstanding quality, and
completed at all.
through on work assignments. Shows interest in contributing to
completed on schedule. Highly motivated to improve
success of department.
personal contribution to department's goals.
Rating: Comments:
Working Relationships/Interpersonal Skills: Incumbent must demonstrate the ability to relate to and interact with others in a positive way that results in
cooperation, mutual respect and common benefit. Consider employee's expressed attitude towards his/her work; tact and cooperation shown in dealing with
customers, fellow employees and members of management; the spirit in which assignments are accepted; willingness to work with other employees and
departments toward a common objective. Is employee cooperative even when overruled; helpful to others and tolerant of their expressed opinions and
suggestions?
1
2
3
4
5
Reluctant to help; apathetic and uncooperative. Does all possible
Cooperative and courteous most of the time. Team player.
Excellent rapport with others. Offers constructive
to gain advantage for self and department at expense of peers.
Relates well with staff and public. Regarded as competent by
suggestions. Goes the "extra mile" in showing concern for
Distrusted, excluded by peers, who feel "used" and manipulated.
peers.
co-workers and the public. Highly regarded by peers, who
seek advice and help. A true "friend" to peers, who build a
strong relationship of equals. Strong bond of trust from and
for others.
Ratings:
Comments:
Adaptability: Incumbent is evaluated on the ability to adapt to multiple demands or changing priorities, and accommodate emergencies; willing to learn new
skills and assume new responsibilities; responsive to direction. Consider employee's willingness and ability to perform other work in his/her department and
the application of current job knowledge to new and unfamiliar work. Does employee grasp instructions and learn quickly? Consider employee's flexibility
regarding change and his/her reaction to pressure. Also consider -- the ability to change approaches or methods based upon circumstances unique to a
particular situation in order to achieve desired results.
1
2
3
4
5
Has not adapted to job requirements. Resists instruction.
Willing to try new duties or procedures with positive attitude.
Welcomes new situations positively and as a challenge.
Complains rather than trying new situations.
Works well under pressure.
Encourages the same behavior in others. Makes
constructive suggestions for improvement.
Rating:
Comments:
Performance Evaluation Page 4
Judgment/Problem Solving/Decision Making: Incumbent is evaluated on the ability to recognize problem and inconsistencies, gather information required
to isolate or define a problem, and either effect a solution or seek assistance as appropriate; ability to think and act independently or with minimal supervision.
Consider the degree to which he/she obtains the proper number of facts commensurate with the problem before making a decision, how well he/she weighs
the facts and alternatives available, his/her ability to discriminate between major and minor factors, and the speed of his/her decision once all factors are
known. Does he/she exercise sound reasoning? Does he/she visualize all sides of an issue and generate alternatives?
1
2
3
4
5
Inability to realize consequences of actions. Decisions are often
Good judgment resulting from sound evaluation of factors. Most
Consistently and quickly arrives at correct decision even on
wrong or ineffective. Judgment causes problems too often to be
decisions and actions are correct. Generally makes sound
highly complex matters. Keeps head when others are losing
acceptable. Fails to handle pressure situations, has to be helped.
decisions under stress. May need assistance with unfamiliar
theirs. Makes best decisions under stress. Courageous,
Cannot deal with complexity of decisions -- avoids coming to
situations. Generally pragmatic and sensible.
resolute; faces up to difficult issues, and deals effectively
grips with situations. "Ducks" difficult issues if possible; avoids
with them. Extremely pragmatic; sensible. Politically astute.
Not only "intelligent" but also "wise.” Realistic to a high
them or pushes them off on others. Does not think things through
completely. Does not use common sense very well. Has no
degree.
sense of what is appropriate or realistic. Impractical; insensitive.
Does things other view as clearly "not smart."
Rating:
Comments:
Communication: Incumbent is evaluated on the ability to accurately and effectively transmit and receive information that is necessary to accomplish goals
and objectives. Consider employee's ability to recognize and fulfill the need to inform others as necessary; make a conscious effort to give explicit
instructions, make sure that he/she understood, encourage feedback and listen carefully to others; ability to represent and communicate the City's best
interests. Also, consider -- effectiveness of written communication skills.
1
2
3
4
5
Written materials are unclear, confusing. Spelling and
Written materials are generally clear and concise, with adequate
Excellent writer. Conveys facts and points of decision
grammatical errors abound. Has to be closely monitored to obtain
grammar and punctuation. Oral communications are generally
logically, concisely. Uses proper grammar and spelling;
acceptable reports. Oral communications are unclear and
clear. Adequate explanation of concepts and ideas. Listens and
corrects typographical errors without prompting. Excellent
confusing. Cannot adequately explain concepts or ideas.
generally responds well to opposing viewpoints.
verbal communicator. Ensures that others understand
Dominates, or attempts to dominate, conversation. Interrupts
thoughts and ideas. An excellent listener. Permits others to
others; rejects contrary views.
express views freely and considers others' thoughts
carefully. Demonstrates understanding of what others have
said when responding or making a point.
Rating: Comments:
Dependability: Incumbent is evaluated on the ability to get the job done with minimum supervision. Considerations are acceptance of responsibility, being
conscientious and ability to meet accuracy and deadlines requirements.
1
2
3
4
5
Assignments not always carried through; requires close scrutiny to
Generally dependable. Can usually be relied upon to follow
Can always be counted upon to complete assignments; work
insure compliance; work may be late, of poor quality, or not
through on work assignments. Shows interest in contributing to
produced is of consistently outstanding quality and
complete at all.
success of department.
completed on schedule.
Rating:
Comments:
Commitment to Safety:
Incumbent is evaluated on the ability to adhere to safety rules and regulations, and the ability to recognize potentially
dangerous/hazardous situations. Consider employee's attitude towards safety work rules. Does employee follow procedures established to promote safety?
Does employee wear required personal protective equipment? Does employee practice good housekeeping habits -- the orderliness and cleanliness of
his/her work area?
Employee does not meet expectations
Employee meets expectations
Customer Service: Incumbent is evaluated on his/her commitment to providing optimal customer service. Considerations include actions taken to
continually improve services, refine and streamline processes, and increase responsiveness. Also included -- demonstrating a service oriented attitude in all
contacts with the public, employees and other agency representatives; looking for ways to assist the public and meeting the needs of the individual.
Personally implements and assures that the department implements the City Administration’s guiding values: We are here to serve our citizens; we treat our
citizens, others customers, and co-workers with dignity and respect; we are here to help Broomfield be a safe and enjoyable community; we care and we
show it; we provide quality services; we respond quickly; we follow-up; we are professional; we are courteous; we are fair; we are positive.
1
2
3
4
5
Shows little interest in assisting customers to determine needs.
Generally demonstrates sincere interest in assisting and satisfying
Is universally helpful and courteous in personal dealings,
May appear indifferent or abrupt at times.
customers.
even if others are abrasive. Acknowledges role as public
servant.
Rating:
Comments:
Performance Evaluation Page 5
Planning/Organizational Abilities: Incumbent is evaluated on the ability to set priorities, forecast needs, effectively use financial and human resources,
schedule activities, and determine proper course of action. Consider ability to plan objectives or goals, organize work, direct the flow of work, delegate
responsibilities when appropriate and follow through to achieve results. Does he/she adhere to City policies and procedures and established schedules to
accomplish his/her work; maintain flexibility to schedule unforeseen events?
1
2
3
4
5
Responds to stimuli "after the facts.” Is often caught unaware by
Sometimes anticipates problems before they arise. Generally
Always anticipates problems before they arise and acts to
unforeseen events or circumstances. Is generally seen as
determines appropriate course of action. Generally uses time
deal with them before they become crises. Prepares for
reacting to problems rather than being in charge of situations.
wisely. Organizes workload to meet priorities.
possible circumstances or side effects. Thinks "a move or
two in advance.” Extraordinary ability to analyze a
Too frequently wastes time due to duplicated efforts,
mismanagement of resources or misplaced materials.
problem/need and to effectively coordinate resources to
accomplish goals. Consistently displays creative and
innovative methods in organizing workflow and activities.
Rating:
Comments:
Initiative: Incumbent is evaluated on the ability to demonstrate self-motivation in resolving issues without awaiting a directive and the desire to learn new
things/skills. Consider the degree to which the employee is a self-starter, goes ahead with jobs without having to be told (within the limits of his/her job) and
carries them out through to completion.
Consider amount of supervision required; employee's interest in taking on additional assignments and
responsibilities. Is employee creative in handling difficult assignments? Does he/she introduce new, creative ideas or courses of action? Does he/she take
calculated risks to resolve problems?
1
2
3
4
5
Does not seek ways to improve individual or department
Often seeks ways to improve individual and department
Always looks for ways to improve, and initiates without
performance.
performance
prompting. Challenges status quo and offers viable
solutions.
Rating:
Comments:
Leadership: Incumbent is evaluated on the ability to influence the activity of others in a desired direction, often by setting an example and establishing
credibility, thereby inspiring employees' trust and loyalty. Consider the ability to lead and train others and to get results through teamwork; the ability to
inspire confidence; the ability to inspire employees to adhere to City policies and procedures.
1
2
3
4
5
Disrupts group processes, reinforces divisiveness, distrust.
Presents positive image and provides adequate direction and
Consistently constructive, exceptionally helpful without
Tends to break down group consensus. Avoids situations
leadership. Generally involves group in problem solving.
expecting personal recognition or gain. Is instrumental in
requiring leadership, direction and control.
building group consensus.
Rating:
Comments:
Budgetary Controls/Commitment to Productivity/Administration of Resources: Incumbent is evaluated on the ability to control costs, exercise economy
and effectively maximize the available resources. Considerations include performance in contributing to department/City plans, ability to forecast and
maintain budgetary projections, and wisely use, track and approve departmental expenditures.
1
2
3
4
5
Classic bureaucratic behavior; seeks to maximize budget, enlarge
Generally seeks ways to improve productivity. Generally
Solidly committed to productivity improvement; constantly
seeking ways to do "more with less.” Enlargement of budget
sphere of influence. Consistently asks for more people, bigger
demonstrates ability to work within budget constraints and track
budget. Views budget as money to be spent, rather than
departmental expenses.
is not the goal; better performance is. Make best use of
resources to be used to deliver services. Pays no attention to
resources. Controls expenditures carefully; is aware of
expenditures. Is unaware of status throughout year. Expects
weak areas, and acts to correct them before trouble occurs;
others to worry. Sometimes over-runs budget.
consistently finishes year without budget overruns.
Rating:
Comments:
Motivation and Development of Subordinates/Relationships with Subordinates/Ability to Delegate: Incumbent is evaluated on the ability to recognize
performance strengths and limitations of subordinates, use coaching and mentoring techniques to effectively help them overcome their limitations, and to
motivate subordinates to achieve their maximum potential. Considerations include timely completion of assignments and evaluations, ability to delegate
responsibilities, effectiveness of performing in training, coaching, mentoring and developing subordinates.
1
2
3
4
5
Hoards good employees, inhibiting their opportunities for
Recognizes employees' strengths and limitations. Generally
Sincerely wants subordinates to achieve personally. Will
progress. Lets them make avoidable mistakes so they won't look
displays effective coaching techniques. Generally respected and
assist their progress, even if it means helping them go on to
"too" good. Fails to guide or motivate employees. Is disliked, even
admired by subordinates. Often delegates assignments. Provides
another department or organization. Helps them avoid
feared, by subordinates, who feel alienated, confused or fearful
adequate instructions in order to complete tasks.
pitfalls to their own success. Department employees regard
for their futures. Either doesn't delegate at all, or gives work but
him/her highly. Is seen as an excellent leader and role
doesn't monitor progress, and is caught short when subordinates
model for success. Is sincerely interested in employees as
fail assignments. Out of touch with what's going on.
persons. Makes best possible use of subordinates' skills.
Parcels out work to others, and then keeps touch with
progress of sub-tasks, and coordinates overall
accomplishments.
Rating:
Comments:
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