Employee Performance Evaluation Form - Bsm Consulting

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Employee Performance Evaluation
Name:
Job Title:
Date of Hire:
Date of Review:
Supervisor Completing Evaluation:
Rating is on a scale of 1 to 5 with 1 being the LOWEST and 5 being the HIGHEST.
1 = Unsatisfactory; 2 = Below Average; 3 = Satisfactory; 4 = Above Average; 5 = Exceptional
Criteria
Employer Evaluation
Commitment to the Vision: Recognizes the company’s vision and will
Rating: ______
do whatever it takes to get the job done.
Comments:
Specific Job Skills: Performs work in a manner that shows a high
Rating: ______
degree of competence and capability with a minimum of supervision.
Comments:
Displays knowledge and understanding of assigned duties.
Initiative and Good Judgment: Initiates and sets directions, assumes
Rating: ______
responsibility, and exercises good judgment.
Comments:
Team Player: Demonstrates a willingness to support the group as a
Rating: ______
whole and works in harmony with others. Shows a willingness to share
Comments:
responsibility and a willingness to help others.
Efficiency and Accuracy: Uses time effectively and with a minimum of
Rating: ______
error. Does work with thoroughness and in a reasonable amount of time.
Comments:
Commitment to Quality: Performs quality work and has an eye for
Rating: ______
detail.
Comments:
Communication Skills: Shows evidence of effective oral and written
Rating: ______
communication with co-workers and patients.
Comments:
Punctuality and Attendance: Begins work on time and conforms to
Rating: ______
work hours and schedule.
Comments:
Attitude and Courtesy: Displays politeness, helpfulness, and a good
Rating: ______
attitude and frame of mind when dealing with patients and co-workers.
Comments:
© 2009, BSM Consulting
1
Employee Performance Evaluation
Name:
Job Title:
Date of Hire:
Date of Review:
Supervisor Completing Evaluation:
Rating is on a scale of 1 to 5 with 1 being the LOWEST and 5 being the HIGHEST.
1 = Unsatisfactory; 2 = Below Average; 3 = Satisfactory; 4 = Above Average; 5 = Exceptional
Criteria
Employer Evaluation
Commitment to the Vision: Recognizes the company’s vision and will
Rating: ______
do whatever it takes to get the job done.
Comments:
Specific Job Skills: Performs work in a manner that shows a high
Rating: ______
degree of competence and capability with a minimum of supervision.
Comments:
Displays knowledge and understanding of assigned duties.
Initiative and Good Judgment: Initiates and sets directions, assumes
Rating: ______
responsibility, and exercises good judgment.
Comments:
Team Player: Demonstrates a willingness to support the group as a
Rating: ______
whole and works in harmony with others. Shows a willingness to share
Comments:
responsibility and a willingness to help others.
Efficiency and Accuracy: Uses time effectively and with a minimum of
Rating: ______
error. Does work with thoroughness and in a reasonable amount of time.
Comments:
Commitment to Quality: Performs quality work and has an eye for
Rating: ______
detail.
Comments:
Communication Skills: Shows evidence of effective oral and written
Rating: ______
communication with co-workers and patients.
Comments:
Punctuality and Attendance: Begins work on time and conforms to
Rating: ______
work hours and schedule.
Comments:
Attitude and Courtesy: Displays politeness, helpfulness, and a good
Rating: ______
attitude and frame of mind when dealing with patients and co-workers.
Comments:
© 2009, BSM Consulting
1
Criteria
Employer Evaluation
Personal Accountability: Accepts full responsibility for his/her actions.
Rating: ______
Comments:
Flexible and Adaptable: Willingly accepts and responds to direction,
Rating: ______
changing conditions, constructive criticism, and delegated assignments.
Comments:
Gossip and Confidentiality: Speaks with good purpose. Does not
Rating: ______
become involved and party to gossiping or negativity. Maintains
Comments:
confidentiality of patient records and office business in and out of the
office.
Personal Appearance: Shows appropriate concern for cleanliness,
Rating: ______
good grooming, neatness, and dress.
Comments:
Total Score: ______ out of a possible 65
Comments:
Supervisors Comments/Recommendations:
_______________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Employee Comments/Concerns: ___________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_________________________________________________
________________________________
Supervisor Signature
Date
_________________________________________________
________________________________
Employee Signature
Date
© 2009, BSM Consulting
2

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