Title Page
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Site conducted
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Conducted on
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Prepared by
EMPLOYEE INFORMATION
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Employee Name
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Job position/title
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Department
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Immediate supervisor
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Next level supervisor
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Does she meet the requirements of the task?
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Does she need help understanding the task?
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On a scale of 1-5, with 5 being the best, how would you rate her performance?
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Is there anything you feel she could improve on?
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Do you have any suggestions on how we could improve our process?
FEEDBACK
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List of the ended quarter's objectives
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Result summary; Key results achieved and or missed in previous
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Detailed employee's strengths/achievements
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Detailed aspects requiring improvement
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Challenges encountered/experienced
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Next quarter's goals/expectations
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What help do you need from the management
PERFORMANCE ASSESSMENT
RATINGS
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Attendance
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Job Knowledge and Skills
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Quality of work
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Initiative and motivation
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Teamwork
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General conduct
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Discipline
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Communication
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Co-worker relations
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Individual effectiveness
CONFIRMATION
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Overall Performance Rating
COMMENTS AND APPROVALS
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Supervisor's comments
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Supervisor's signature
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Reviewer's name
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Reviewer's signature
