Title Page

  • Date and Time of Review

  • Department

  • Employee (Full Name)

  • Employee Number

  • Job Title

  • Supervisor (Full Name)


  • What were your most significant work-related accomplishments? (Include projects, assignments, new skills or knowledge gained.)

  • How do these accomplishments relate to your key responsibilities and goals for you and your unit/department?

  • What didn’t you accomplish that you had planned on accomplishing? Why?

  • What are your goals for the next evaluation period?

  • How will you accomplish these goals?

  • What do you need to accomplish these goals?

  • How can your supervisor help you to work more effectively and support your goals?

  • How can your team help you achieve your goals?

  • What additional training or development would help you improve and/or enhance your work performance?


  • What feedback or suggestions do you have to improve your unit and/or department?

  • Employee (Full Name and Signature)

  • Supervisor (Full Name and Signature)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.