"Employee Performance Evaluation Form - University of Arkansas System"

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PMGS-08-1
Policy and Management Guidelines
Division of Agriculture
Rev. August 2013
EMPLOYEE PERFORMANCE EVALUATION FORM
PART I – RATED EMPLOYEE IDENTIFICATION
Name (Last, First, MI)
Employee I.D. Number
Institution
Position Title
Grade
Position Number
PART II – RATER EMPLOYEE IDENTIFICATION
Name of Rater (Last, First, MI)
Telephone Number
Position Title
PART III – REVIEWING OFFICIAL EMPLOYEE IDENTIFICATION
Name of Reviewing Official (Last, First, MI)
Telephone Number
Position Title
PART IV – PERFORMANCE STANDARDS
Duty Area:
Relative Importance:
A
B
C
Self Management
Standards:
Results:
Comments/Justification (required for rating other than satisfactory):
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory):
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory):
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory) :
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory) :
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
PMGS-08-1
Policy and Management Guidelines
Division of Agriculture
Rev. August 2013
EMPLOYEE PERFORMANCE EVALUATION FORM
PART I – RATED EMPLOYEE IDENTIFICATION
Name (Last, First, MI)
Employee I.D. Number
Institution
Position Title
Grade
Position Number
PART II – RATER EMPLOYEE IDENTIFICATION
Name of Rater (Last, First, MI)
Telephone Number
Position Title
PART III – REVIEWING OFFICIAL EMPLOYEE IDENTIFICATION
Name of Reviewing Official (Last, First, MI)
Telephone Number
Position Title
PART IV – PERFORMANCE STANDARDS
Duty Area:
Relative Importance:
A
B
C
Self Management
Standards:
Results:
Comments/Justification (required for rating other than satisfactory):
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory):
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory):
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory) :
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory) :
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
PMGS-08-1
Policy and Management Guidelines
Division of Agriculture
Rev. August 2013
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory) :
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory) :
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory) :
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Duty Area:
Relative Importance:
A
B
C
Standards:
Results:
Comments/Justification (required for rating other than satisfactory) :
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
PMGS-08-1
Policy and Management Guidelines
Division of Agriculture
Rev. August 2013
Approval of Duty Areas and Standards
Complete at the beginning of the rating period:
My rater and I have established the above duty areas and standards, and I understand my performance during the coming rating period will be measured
against them.
Employee’s Signature:
___________________________________
Date: _______________________________________
Rater’s Signature:
___________________________________
Date: _______________________________________
I have reviewed these duty areas and standards and agree that they are appropriate for the position.
Reviewing Official’s Signature ___________________________________
Date: _______________________________________
PMGS-08-1
Policy and Management Guidelines
Division of Agriculture
Rev. August 2013
PART V – OVERALL RATING
Overall Rating: It is understood that an Unsatisfactory in any field above precludes awarding an Exceeds Standard or Above Average
rating during this period. The overall rating received is determined at the discretion of the rating official.
Exceeds Standard
Above Average
Satisfactory
Unsatisfactory
Rating Period Beginning Date:
Rating Period Ending Date:
This employee has received a written reprimand or disciplinary notice since the last performance
Yes
No
evaluation rating.
Approval of Overall Rating
Complete at the end of the rating period:
By signing below the rater verifies that he/she has consulted with the reviewing official on the justification for any overall rating other than “Satisfactory.”
Rater’s Signature:
Date:
By signing below the employee concurs only that the performance evaluation has been conducted. The employee’s signature does not indicate that he or
she agrees with the evaluation. Comments concerning performance may be submitted on a separate sheet.
Employee’s Signature:
Date:
By signing below the rater certifies that the performance evaluation has been completed and forwarded to the reviewing official.
Rater’s Signature:
Date:
Reviewing Official’s Signature:
Date:
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