EMPLOYEE APPRAISAL FORM - 2015

Employee Name:

Dr. Ayesha Shamshad

Department / Branch/
Division:

Head Office

Location:

Health Department

HRD Code:

HR/HO/HID/0132

Cadre:

Assistant Manager

Employee #:

115465

Effective evaluation of job performance is a continuous process throughout the year. This form is to be used for annual
evaluations. It may also be used at other times during the year when formal feedback is needed.

Rating Scale
Rating 5

Outstanding
Performance far exceeds expectations. Exceptionally high quality of work performed in all essential areas of
responsibility. Quality of work/contribution is superior and is key contributor to department and organizational
objectives. This individual self motivated to produce top quality performance and results. A development plan needs to
be completed for staff rated 5 in order to leverage on the employees strengths and ensure retention.

Rating 4

Very Good
Performance exceeds expectations in essential areas of responsibility, and the quality of work overall is excellent.
Annual goals are met or exceeded consistently.

Rating 3

Good
Performance meets expectations in essential areas of responsibility, at times even exceeding expectations, the quality
of work overall is good. Meets all critical annual goals 100%.

Rating 2

Fair
Performance does not consistently meet expectations performance fails to meet expectations in one or more
essential areas of responsibility, and one or more of the most critical goals were not met. A professional development
plan to improve performance must be outlined in Section 5, including timelines, and monitored to measure progress.

Rating 1

Poor
Performance is consistently below expectations in most essential areas of responsibility, and/or reasonable progress
toward critical goals is not made. Significant improvement is needed in one or more important areas. A development
plan to correct performance, including timelines, must be outlined and monitored to measure progress.

e is

Employee Appraisal Form Page 1 of 5

Section 1 Goals Vs. Achievement

Rate the progress made on each of the goals which were established at the beginning of the period. It is mandatory to
document the rationale and justification for each rating in the appropriate space provided and assigned score on a scale
of 1-5 (1=lowest; 5 = highest)

S.No.

Set weights for each goal according to

departmental priority. Each goal should
Include clear measures and targets.
(SMART format)

Financials:

Customer:

Process:

People Management:

Total Score (OVERALL RATING)

Achievements

Weightage
(a)

Score
(b)

Total 100%

(1 - 5)

Weighted
Score
(a) x (b)

Name:

Employee #:

HRD Code:

Employee Appraisal Form Page 2 of 5

Section 2 Competencies
These include knowledge, skills and basic abilities. Rate each factor based on performance during the period identified
above on a scale of 1-5 (1=lowest; 5 = highest). The factors include knowledge and skills required in order to be successful
in the position. It is mandatory to provide a justification for each rating. There is no weightage for the competencies these
are to be used as guidelines for employee development only.

Provide Justification / Rationale for

each rating
a) Analytical Skills:
Has ability to visualize, articulate and solve problems and
make decisions based on available information, has ability
to apply logical thinking in gathering and analyzing data.

b) Teamwork:
Cooperates and collaborates with colleagues. Participates
and contributes towards job/task/project as appropriate;
works in partnership with others.
c) Customer Focus:
Ensures efficient, effective, high quality service to the
customer at all times. Takes care of customer needs in a
positive and effective manner.
Strives to maximize the total value to the customer and is
commitment to providing value added services to external
and internal customers.
d) Innovation/ Creativity:
Has ability to implement radical and revolutionary changes
in thinking, products and processes involving generation
of new ideas or concepts.

e) Decision Making:
Demonstrates ability to identify and analyze problems and
take appropriate actions / decisions to resolve issues.

f)

Interpersonal Skills:
Has well developed Interpersonal skills required for
building strong relationships, dealing with and relating to
other people, largely on a one- to-one basis.

g) Communication:
Connects with peers, subordinates and customers.
Actively listens, clearly and effectively shares information.
Demonstrates effective oral and written communication
skills.
h) People Management - (To be completed for individuals
with people management responsibility):
Manages staff by being clear about what is to be
achieved, how it is to be done, to what standards, by
when, within what budget, motivates them and ensures
accountability for delivery.
i)

Work Knowledge:
Demonstrates solid professional knowledge and
understanding of principles and practices pertaining to the
job.

Rating
(1 5)

Name:

Employee #:

HRD Code:

Employee Appraisal Form Page 3 of 5

Section 3 Overall Rating

Section 3 Overall Rating
Please insert overall rating of Section 1 (Page # 2) only.
OVERALL RATING
5

Outstanding

Very Good

Good

Fair

Poor

Section 4 Overall Comments

Section 4 Overall Comments
This section includes employees and managements
concurrence/agreement of all concerned parties.

comments

as

well

as

written

acknowledgement

and

Appraisers Comments & signature

_________________________
Appraisers Name & Signature

__________________
Date

Department/ Functional/ Divisional Head Comments & signature

________________________
Heads Name & Signature

__________________
Date

Employee Comments & signature

_______________________
Employees Signature

___________________
Date

HR Comments

__________________________
Signature of HR Representative

___________________
Date

Name:

Employee #:

HRD Code:

Employee Appraisal Form Page 4 of 5

Section 4 Employee Development Plan

Employees areas of development as identified through the appraisal process should be highlighted in this section. Include
specific development actions to be taken and realistic timeframes / dates.
These actions should be completed by the appraiser jointly with the appraisee.

Current Year (2012)

Training & Development

Plan
(Training/ Job Rotation/
Special Projects)

Status/Remarks

Next Year (2013)

Training & Development
Plan
(Training/ Job Rotation/
Special Projects)

Action Plan &

Target Date

Status/Remarks

Note: Please keep a photocopy of this section. The Employee Development Plan is to be referred to throughout the year to
incorporate any changes and to ensure plan is implemented on target dates identified.

Signature of Appraisee
Name:

Signature of Appraiser
Employee #:

HRD Code:

Employee Appraisal Form Page 5 of 5