Self-Assessment Employee Evaluation Form - duplicate

• Date and Time of Review

• Department

• Employee (Full Name)

• Employee Number

• Job Title

• Supervisor (Full Name)

Self-Assessment

• 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?

Compentancy Assessment

• How well do you understand the fire alarm system and related components? (IE. PC, Field devices, Fire Pumps)

  Good

  Fair

  Poor

  N/A

• Could you teach others about the Fire alarm system and related components?

  Yes

  No

  N/A

• How well do you understand the Steam Boiler system?

  Good

  Fair

  Poor

  N/A

• Could you teach others about the Steam Boiler system?

  Yes

  No

  N/A

• How well do you understand the Chiller water system?

  Good

  Fair

  Poor

  N/A

• Could you teach others about the Chilled Water system?

  Yes

  No

  N/A

• How well do you understand the Primary Chilled water system and associated pumps?

  Good

  Fair

  Poor

  N/A

• Can you teach others about the Primary Chilled Water pumps and system?

  Yes

  No

  N/A

• How well do you understand the Secondary Chilled water system?

  Good

  Fair

  Poor

  N/A

• Could you teach others about the Secondary Chilled water System and Pumps?

  Yes

  No

  N/A

• How well do you understand the Cooling towers and associated pumps?

  Good

  Fair

  Poor

  N/A

• Could you teach others about the Cooling towers and associated Pumps/Components?

  Yes

  No

  N/A

• How well do you understand the Generators and associated parts? (IE. ATS, Breaker panels, Fuel system)

  Good

  Fair

  Poor

  N/A

• Could you teach others about the Generators and associated systems?

  Yes

  No

  N/A

• How well do you understand what an Air Handler unit does and its associated systems?

  Good

  Fair

  Poor

  N/A

• Could you teach others about the Air Handling units and the associated controllers within the system?

  Yes

  No

  N/A

• How well do you understand what an Exhaust fan does and how to maintainance it?

  Good

  Fair

  Poor

  N/A

• Could you teach others about the Maintainance of an Exhaust fan system?

  Yes

  No

  N/A

• How do you rate yourself if an emergency was to occur on your shift?

  Good

  Fair

  Poor

  N/A

Completion

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

• Employee (Full Name and Signature)

  Sign

• Supervisor (Full Name and Signature)

  Sign

• Yes

  No

  N/A