Self-Assessment Employee Evaluation Form

• Date and Time of Review

  Date

• 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?

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