"Performance Review Form - Leaders - University of Rochester"

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FY17   P erformance   R eview   F orm - Leaders
Review Type:  
Employee Name: ___________________________________________ Date: _____________
      S elf-­‐assessment  
      A nnual  
Job Title: ___________________________________________________ Job Code: _________
      I nterim   /   O ff-­‐cycle  
Division/Department: ___________________________________________________________
      P robationary  
      T ransfer  
Manager Name (Reports to): _____________________________________________________  
Performance   r eviews   a re   a   k ey   c omponent   o f   e mployee   d evelopment.     T his   e valuation   i s   i ntended   t o   b e   a   f air   a nd   b alanced  
assessment   o f   t he   e mployee's   p erformance   s ince   t he   l ast   r eview.     M eaningful   t wo-way   f eedback   p rovides   t he   e mployee   and   t he  
manager   w ith   a n   u nderstanding   o f   h ow   p ast   p erformance   c ombined   w ith   a   r eview   o f   e xpectations   c reates   a n   e nvironment   f or  
career   g rowth   a nd   c ontinuous   i mprovement.  
Goals   &   K ey   R esponsibilities  
This   s ection   p rovides   e mployees   a nd   m anagers   w ith   t he   a bility   t o   r ate   a nd   c omment   o n   c urrent   y ear   p erformance   g oals   a nd/or  
key   j ob   r esponsibilities.     A ll five goals & key responsibilities must be rated in order for this section to provide an accurate score.
4
1
2
3
5
Not Meeting
Needs Some
Fully Meets
Fully Meets & Often
Consistently Exceeds
Expectations
Improvement
Expectations
Exceeds Expectations
Expectations
Score:   _ ______  
1.
2.
Score:   _ ______  
3.
Score:   _ ______  
4.
Score:   _ ______  
Score:   _ ______  
5.
Average Score: _______  
0.0
Page   1  
FY17   P erformance   R eview   F orm - Leaders
Review Type:  
Employee Name: ___________________________________________ Date: _____________
      S elf-­‐assessment  
      A nnual  
Job Title: ___________________________________________________ Job Code: _________
      I nterim   /   O ff-­‐cycle  
Division/Department: ___________________________________________________________
      P robationary  
      T ransfer  
Manager Name (Reports to): _____________________________________________________  
Performance   r eviews   a re   a   k ey   c omponent   o f   e mployee   d evelopment.     T his   e valuation   i s   i ntended   t o   b e   a   f air   a nd   b alanced  
assessment   o f   t he   e mployee's   p erformance   s ince   t he   l ast   r eview.     M eaningful   t wo-way   f eedback   p rovides   t he   e mployee   and   t he  
manager   w ith   a n   u nderstanding   o f   h ow   p ast   p erformance   c ombined   w ith   a   r eview   o f   e xpectations   c reates   a n   e nvironment   f or  
career   g rowth   a nd   c ontinuous   i mprovement.  
Goals   &   K ey   R esponsibilities  
This   s ection   p rovides   e mployees   a nd   m anagers   w ith   t he   a bility   t o   r ate   a nd   c omment   o n   c urrent   y ear   p erformance   g oals   a nd/or  
key   j ob   r esponsibilities.     A ll five goals & key responsibilities must be rated in order for this section to provide an accurate score.
4
1
2
3
5
Not Meeting
Needs Some
Fully Meets
Fully Meets & Often
Consistently Exceeds
Expectations
Improvement
Expectations
Exceeds Expectations
Expectations
Score:   _ ______  
1.
2.
Score:   _ ______  
3.
Score:   _ ______  
4.
Score:   _ ______  
Score:   _ ______  
5.
Average Score: _______  
0.0
Page   1  
Co re Co mpetencies
1
2
3
4
5
Fully Meets & Often
Not Meeting
Needs Some
Fully Meets
Consistently Exceeds
Exceeds Expectations
Expectations
Improvement
Expectations
Expectations
Personal Accountability
Commitment to Quality – Takes pride in work, strives for excellence. Takes responsibility for performance and fixes
mistakes. Continually looks to improve the quality/quantity of work.
Safety Consciousness – Contributes to a safe working environment; performs duties in a clean and safe manner. Brings safety
concerns to appropriate parties; takes initiative to resolve when possible.
Attendance and Punctuality – Fulfills work and time requirements. Keeps unschedued absences to a minimum. Plans for
coverage of responsibilities where appropriate.
Reliability/Dependability – Meets task deadlines and work commitments. Fulfills work obligations in a timely and
satisfactory manner. Takes responsibility for personal actions and performance.
Appearance – Dresses appropriately. Avoids wearing strong fragrances or other strong odors (e.g., from smoking). Keeps
workplace neat, clean and organized.
Score: _______  
Supporting Comments and Examples:
Professionalism
Self Awareness – Demonstrates continuous professionalism, respect, and workplace civility. Mindful of actions; topic, tone,
volume, and body language. Avoids gossip.
Working with Others – Approachable, inclusive, and respectful. Exhibits teamwork, takes initiative to help. Courteous and
cooperative. Respects diversity and appreciates differences.
Relationship to Supervisor – Responds and acts cooperatively; works to maintain positive relationships with supervisor/manager.
Accepts responsibility for own actions.
Gives and Receives Feedback – Provides constructive feedback to colleagues. Mindful of both verbal and body
language when giving feedback. Receptive to feedback from others; accepts feedback without defensiveness.
Role Modeling – Conducts self in fair and trustworthy manner. Upholds professional and ethical
standards. Demonstrates departmental and orgranizational values including Integrity, Compassion,
Accountability, Respect, and Excellence.
Score:   _ _______
Supporting Comments and Examples:  
Page   2  
Co re Co mpetencies
4
1
2
3
5
Fully Meets & Often
Not Meeting
Needs Some
Fully Meets
Consistently Exceeds
Expectations
Improvement
Expectations
Exceeds Expectations
Expectations
Functional Expertise
Job Knowledge – Clearly demonstrates functional expertise as it relates to the job. Strives for excellence. Asks relevant
questions when uncertain. Shares information and knowledge with others.
Learning Agility – Keeps abreast of new developments and enhancements to systems, procedures and products. Values learning;
seeks out new learning and development opportunities. Completes learning assignments in a timely manner.
Problem Solving & Decision Making – Uses good judgment when evaluating a problem. Analyzes risks and identifies consequences.
Makes appropriate decisions in a timely manner. Uses problem solving strategies to work through roadblocks and deliver timely
results in a manner that is consistent with organizational values.
Policy Awareness – Understands and adheres to departmental and organizational standards, policies and processes as appropriate.
Asks relevant questions when uncertain. Continuously works to maintain standards.
Use of Resources – Works to reduce waste by identifying ways to be more efficient with time, money, or processes. Where
appropriate is aware of equipment and supply costs; understands appropriate use of resources. Demonstrates a sense of
organizational stewardship.
Score:   _ _______
Supporting Comments and Examples:  
Service Excellence
Treatment Towards Others – Listens carefully, expresses compassion and empathy where appropriate. Mindful of the
perspective and needs of others (e.g. colleagues, patients, students, families and others).
Service Orientation – Embraces organization and department mission. Works to understand goals and objectives of the unit or the
department.
Communication – Communicates ideas and messages clearly and concisely. Actively listens, seeks to understand others. Answers
questions clearly and asks clarifying questions when needed. Keeps others informed when deadlines are challenged.
Productivity – Works to deliver an expected volume of work; seeks operating efficiencies without sacrificing quality. Works to stay
organized. Uses technology as needed/where appropriate.
Responds to Change – Adapts to changing priorities. Handles unexpected situations and does so in a calm and positive manner.
Where appropriate, questions and recommends alternatives to new processes and procedures.
Score:   _ _______
Supporting Comments and Examples:  
Page   3  
Leadership Competencies
1
2
3
4
5
Fully Meets & Often
Not Meeting
Needs Some
Fully Meets
Consistently Exceeds
Exceeds Expectations
Expectations
Improvement
Expectations
Expectations
Effective   C ommunication - Writes   a nd   s peaks   c learly.     A rticulates   i deas   a nd   i nstructions   i n   a   c lear   a nd  
concise   m anner.     E ncourages   d ialogue   a nd   c andor;   m akes   i t   s afe   f or   o thers   t o   v oice   t heir   o pinion.     A ctive  
listener;   t akes   t he   t ime   t o   c onsider   a lternative   p oints   o f   v iew.     K eeps   o thers   i nformed;   c onveys   i mportant  
Score:   _ ______  
information   i n   a   t imely   a nd   e fficient   m anner.      
Partnership   &   T eam   B uilding - Values,   r espects   a nd   i s   o pen   t o   o thers’   p oint   o f   v iew.     R elates   w ell   t o   p eople  
at   a ll   l evels   o f   t he   o rganization.     A ctively   w orks   t o   b uild   a   t eam.     E mpowers   e mployees   t o   t ake   a ction.    
Supports   t eam   d ecisions   b oth   p ublicly   a nd   p rivately.   M anages   c onflict;   b uilds   c ommon   g round,   f ocuses   o n  
Score:   _ ______  
the   p ositive   a nd   s eeks   c onstructive   o utcomes.     D emonstrates   c are   a nd   c oncern   f or   a ll   t eam   m embers   a nd  
those   w e   s erve.  
Organizational   E ffectiveness - Takes   i nitiative   t o   g et   t hings   d one.     A ctively   s ets   p riorities.     R uns   e ffective  
meetings;   s tarts/stops   o n   t ime,   m aintains   f ocus   o n   t opic.     A nalyzes   s hort-term   a nd   l ong-term   r isks;  
identifies   p ros   a nd   c ons;   e valuates   o ptions   a nd   c hooses   e ffective   s olutions.     M akes   c ritical   d ecisions   i n   a  
Score:   _ ______  
timely   m anner.  
Performance   M anagement - Tracks,   m onitors,   a nd   d ocuments   e mployee   p erformance.     A ctively  
encourages   g oal   s etting.     P rovides   t imely,   e ffective,   a nd   c onstructive   f eedback.     H olds   t eam   m embers  
accountable   f or   t heir   p erformance   a nd   r esults.     D elegates   t asks   a ppropriately.     C reates   a n   e nvironment  
Score:   _ ______  
where   e mployees   a nd   o thers   f eel   v alued   a nd   a ppreciated.     R outinely   r ecognizes   t eam   m embers   f or   t heir  
contributions   f ormally   a nd/or   i nformally.  
Leading   C hange   &   I nnovation - Champions   c hange   a nd   i nnovation.     R eadily   a dapts   t o   c hange,   m akes  
adjustments   w hen   n eeded.     H elps   o thers   o vercome   r esistance   t o   c hange.     S tays   c alm   i n   t he   f ace   o f   g reat  
change.     A ctively   e ncourages   a nd   s upports   n ew   i deas.     L eads   p rocess   i mprovement,   e ncourages   e fficiency,  
Score:   _ ______  
works   t o   b uild   v alue   f or   t he   o rganization.     H elps   d evelop   i nnovative   s olutions.  
Stakeholder Focus - Maintains  positive  and  collaborative  connection  to  key  stakeholders.    Understands  
needs,  goals  and  objectives  of  all  constituent  groups.    Works  to  create,  monitor,  and  exceed  key  metrics  
Score:   _ ______
and   t argets   i n   s upport   o f   k ey   g roups.      
Strategic   T hinking   &   P lanning   - Ability   t o   s ee   t he   b ig   p icture   b y   t hinking   c onceptually,   i maginatively,   a nd  
systematically.     V isionary   a nd   f orward   t hinking;   a ble   t o   s ee   l ong-term   o pportunities.     D emonstrates   t he  
ability   t o   d evelop   e ffective   p lans   i n   l ine   w ith   o rganizational   g oals.     A ctively   s ets   p riorities.   Works   t o   f ocus  
Score:   _ ______
energy   a nd   r esources   t oward   c ommon   o rganizational   o bjectives.  
Industry   /   R egulatory   C ompliance   K nowledge   - Exhibits   k nowledge   o f,   a nd   e nsures   c ompliance   w ith,   f ederal  
and   s tate   r egulatory   r equirements   ( for   e xample:   A ffirmative   A ction,   F LSA,   N Y   W age   a nd   H our   L aws,   H IPAA,  
Joint   C ommission,   n on-discrimination   l aws,   F ERPA,   e tc.).     I nitiates   a ppropriate   f ollow-up   w hen   c oncerns   a re  
Score:   _ ______
identified.     D emonstrates   i ncreasing   k nowledge   o f   t he   o rganization,   i ndustry   a nd   m arketplace.     L everages  
industry   k nowledge   a nd   b usiness   a cumen   t o   m ake   a ppropriate   d ecisions.     K eeps   a breast   o f   n ew  
developments   w ith   o rganizational   s ystems,   p rocedures,   a nd   p olicies.      
0.0
Average Score:   _ _______
Supporting   C omments   a nd   E xamples:  
Page   4  
Performance Goal Planning
The   p urpose   o f   t his   s ection   i s   t o   c reate   P erformance   G oals   f or   t he   n ext   p erformance   r eview   c ycle.     T hese   n ew  
performance   g oals   w ill   b e   r ated   d uring   t he   n ext   a nnual   p erformance   r eview   c ycle.     T he   c reation   o f   3 -5   performance  
goals   i s   h ighly   r ecommended.  
Goal #1
Goal #2
Goal #3
Goal #4
Goal #5
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