Form EPA-3 "Employee Performance Appraisal" - West Virginia

What Is Form EPA-3?

This is a legal form that was released by the West Virginia Division of Personnel - a government authority operating within West Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 7, 2017;
  • The latest edition provided by the West Virginia Division of Personnel;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form EPA-3 by clicking the link below or browse more documents and templates provided by the West Virginia Division of Personnel.

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Download Form EPA-3 "Employee Performance Appraisal" - West Virginia

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EMPLOYEE PERFORMANCE APPRAISAL
FORM EPA-3
Use this form for the final review of the performance period. See instructions on the previous page.
EMPLOYEE INFORMATION
Employee Name:
Social Security Number:
(
)
last 4 digits – to be completed by the employee
Supervisor’s Name and Title:
Position Title:
Department:
Agency:
Division (and Section):
Rating Period:
Type of Rating
Time in Present
to
Position (
)
Annual
Probationary
Special
in months
RESPONSIBILITIES: Essential duties and responsibilities as identified in the functional job description.
PERFORMANCE STANDARDS and EXPECTATIONS: Objectives to be accomplished during this rating period.
ACKNOWLEDGEMENT: A discussion of duties, responsibilities, performance standards, and expectations for the
current period took place on ______________________ (date from EPA-1 Form). We acknowledge our understanding
of these items and how they will be used to measure work-related performance during this period.
_______________________________________________
_______________________________________________
Supervisor’s Signature
Date
Employee’s Signature
Date
September 7, 2017
EMPLOYEE PERFORMANCE APPRAISAL
FORM EPA-3
Use this form for the final review of the performance period. See instructions on the previous page.
EMPLOYEE INFORMATION
Employee Name:
Social Security Number:
(
)
last 4 digits – to be completed by the employee
Supervisor’s Name and Title:
Position Title:
Department:
Agency:
Division (and Section):
Rating Period:
Type of Rating
Time in Present
to
Position (
)
Annual
Probationary
Special
in months
RESPONSIBILITIES: Essential duties and responsibilities as identified in the functional job description.
PERFORMANCE STANDARDS and EXPECTATIONS: Objectives to be accomplished during this rating period.
ACKNOWLEDGEMENT: A discussion of duties, responsibilities, performance standards, and expectations for the
current period took place on ______________________ (date from EPA-1 Form). We acknowledge our understanding
of these items and how they will be used to measure work-related performance during this period.
_______________________________________________
_______________________________________________
Supervisor’s Signature
Date
Employee’s Signature
Date
September 7, 2017
PERFORMANCE FACTORS and STANDARDS
NEEDS
MEETS
EXCEEDS
IMPROVEMENT
EXPECTATIONS
EXPECTATIONS
Check the rating for each appropriate category
MAINTAINS FLEXIBILITY
Willingly accepts a variety of responsibilities
Adapts to new situations in a positive manner
Displays openness to learning and applying new skills
Works well with others to achieve organization’s goals.
Is resourceful and generally seeks work process improvements
COMMENTS:
DEMONSTRATES CREDIBILITY
Shares information with others when appropriate
Acts independently while keeping supervisor informed
Performs work according to current guidelines and directives
Maintains personal appearance appropriate to job
Exhibits ability to secure and evaluate facts before taking action
COMMENTS:
CUSTOMER SERVICE
Treats all customers with respect
Responds to customers’ needs within appropriate timeframes
Addresses conflicts and problem situations with patience and tact
COMMENTS:
September 7, 2017
West Virginia Division of Personnel
Form EPA-3
Page 2 of 6
PERFORMANCE FACTORS and STANDARDS
NEEDS
MEETS
EXCEEDS
IMPROVEMENT
EXPECTATIONS
EXPECTATIONS
Check the rating for each appropriate category
QUANTITY OF WORK
Work output matches expectations established
Employee completes all assignments
Employee consistently meets deadlines
COMMENTS:
QUALITY OF WORK
Work results satisfy organization’s goals
Work is organized and presented professionally
Work product is thorough and complete
Work product is free of flaws and errors
COMMENTS:
AVAILABILITY FOR WORK
Employee’s attendance supports the expected level of work
Employee’s presence can be relied upon for planning purposes
Employee is a dependable team member
COMMENTS:
Proceed to Page 4 to continue rating if employee is also a supervisor or manager; proceed to Page 5 if employee is not a
supervisor or manager.
September 7, 2017
West Virginia Division of Personnel
Form EPA-3
Page 3 of 6
THIS PAGE IS FOR RATING SUPERVISORS AND MANAGERS ONLY: In addition to the 23 performance elements for all
employees, supervisors and managers shall be rated on the following critical success factors: Leadership, Management,
and Work Environment. Check the appropriate box for each of the 14 performance elements.
PERFORMANCE FACTORS and STANDARDS
NEEDS
MEETS
EXCEEDS
IMPROVEMENT
EXPECTATIONS
EXPECTATIONS
Check the rating for each appropriate category
LEADERSHIP
Provides clear direction and purpose
Models ethical workplace behavior
Demonstrates influencing skills by setting goals
Empowers subordinates to achieve objectives
Acts to motivate, coach, and develop subordinates
COMMENTS:
MANAGEMENT
Organizes and distributes work among subordinates
Secures resources and audits their effective use
Communicates behavioral expectations and performance standards
Monitors, documents, and evaluates employee conduct and performance
Provides appropriate and timely feedback
COMMENTS:
WORK ENVIRONMENT
Maintains a safe and healthy workplace
Builds a team that reflects high morale, clear focus, and group identity
Encourages and provides opportunities for subordinates to obtain and
apply new skills and knowledge
Promotes equal opportunity and protects the rights of all employees
COMMENTS:
September 7, 2017
West Virginia Division of Personnel
Form EPA-3
Page 4 of 6
RATING SCORE SHEET FOR DOP FORM EPA-3
Enter the total number of checks in each rating category, then multiply by the assigned value.
RATING CATEGORIES
COUNT
MULTIPLIER
CATEGORY TOTALS
Exceeds Expectations
X
3 =
Meets Expectations
X
2 =
Needs Improvement
X
1 =
TOTAL ELEMENTS RATED
TOTAL VALUE =
To compute the rating score, divide the total value by the total number of elements rated* to find the overall rating
score. Make certain to carry out your calculation to two decimal places. EXAMPLE: 44 ÷ 23 = 1.91
*37 for a supervisor or manager; 23 for a non-supervisory/non-managerial employee
RATING SCORE
TOTAL VALUE ÷ TOTAL ELEMENTS
÷
=
Once the rating score is determined, enter it below as the Overall Rating Score. Find the corresponding alpha score on
the key below and enter it in the Alpha Score column.
NUMERIC SCORE
ALPHA SCORE
Rating of 1.00 to 1.50
Needs Improvement
KEY
Rating of 1.51 to 2.50
Meets Expectations
Rating of 2.51 to 3.00
Exceeds Expectations
OVERALL SCORE
ALPHA SCORE
SUMMARY
SUMMARY COMMENTS (to be completed by the supervisor or rater)
IMPROVEMENT and/or DEVELOPMENT PLAN (to be completed by the supervisor or rater)
REVIEWING MANAGER’S INITIALS
DATE
September 7, 2017
West Virginia Division of Personnel
Form EPA-3
Page 5 of 6
Page of 6