EMPLOYEE PERFORMANCE APPRAISAL

INSTRUCTIONS

STEPS TO FOLLOW IN THE PROCESS:

PLANNING 1. Schedule time for performance appraisal with employee.

2. Review employee’s job description for accuracy and as necessary,

obtain updated job description.

3. Send employee current job description along with self-evaluation

form to be completed before performance appraisal
administration.

4. Review employee information: past evaluations, last year’s raise,

and goals.

5. Contact employee’s supervisors, peers, subordinates, and patients

to obtain 360 degree feedback.

6. Obtain current year’s performance rating and corresponding merit

pay increase chart.

7. Obtain employee self-evaluation and brainstorm potential

goals/objectives for the upcoming year to discuss at the review.

8. Using 360 degree feedback, employee’s self-evaluation, and your

personal knowledge of employee, evaluate employee on
performance in achieving previous year’s goals and meeting
organizational/departmental competencies.

9. Determine performance rating and pay increase based on results

of evaluation ratings.

10. Submit performance rating and pay increase information into

database for approval by upper management.

PERFORMANCE
1. Meet with employee for review of performance appraisal.
APPRAISAL
ADMINISTRATION 2. Provide feedback to the employee regarding the employee’s
performance rating on achieving last year’s goals/objectives and
set new objectives or update the previous year’s objectives with
employee.
3. Provide feedback for the employee’s performance ratings on
organizational/departmental competencies.

4. Provide employee with a copy of their updated job description

along with the completed review development plan document and
have them sign and date a copy of the development plan
document.

5. Submit all sections of the employee’s performance appraisal to

Human Resources for their inclusion in the employee’s personnel
record including:
 Part I – Goals
 Part II – System-Wide Competencies/Behaviors
 Part III – Development Plan
 Part IV – Current Job Description
 Self-evaluation

*Employee’s completion of annual competencies is also

submitted to Human Resources – not included in this exercise
 PERFORMANCE APPRAISAL
Employee Name: Charlie Sheen

Employee Number: 00001234

Position Title: Staff Pharmacist

Type of Review: Orientation (6 month)

Annual

Current Review Date:

PERFORMANCE RATING KEY

3 Consistently exceeds expectations

2 Consistently meets expectations

1 Does not consistently meet expectations

and improvement is needed

SUMMARY OF PERFORMANCE RATINGS

PART I RATING (GOALS)
PART II RATING (COMPETENCIES)
SUBTOTAL (PART I & PART II)
Divide by 2 or weight as appropriate
FINAL PERFORMANCE RATING
% INCREASE
EFFECTIVE DATE
 PART I - GOALS
List the goals established for the performance period.

Summarize results achieved and rate using the Performance Rating Key.

GOALS RATING RESULTS ACHIEVED

1. Develop a psychiatric pharmacy rotation
for APPE students and begin precepting.
Start with at least 4 students a year.
Success/progress measured with student
evaluations.

2. Use leadership skills to guide change in

the pharmacy. Take the lead and complete
a project to improve the customer service
pharmacy provides to nursing. Goal to
increase nursing satisfaction with pharmacy
services score up to 50% from previous
year’s score of 30% as measured by survey.

3. Work on teamwork and communication

by exhibiting humility and maintaining
openness to the opinions of others. Goal of
obtaining a reduction in the number of
complaints to management from
pharmacists, technicians, and physicians.

4. Improve on adherence to time and

attendance policy. Goal of a reduction in
late arrivals and “no call no shows” for the
year.

GOALS RATING (average): _______

 PART II – SYSTEM WIDE COMPETENCIES/BEHAVIORS
Assess how the individual achieves the following competencies/behaviors. Enter one rating (1-3) for
each category.

COMPETENCIES RATING COMMENTS

ACCOUNTABILITY

-Meets work commitments with

minimal supervision

-Meets attendance guidelines

-Completes work assignments with

minimal or no reminders

COMMUNICATIONS

-Gives feedback as appropriate

-Effectively expresses ideas verbally

and in writing

-Keeps others informed

-Displays positive outlook and

manner

-Exhibits tact and consideration

-Selects uses appropriate

communication methods

FLEXIBILITY

-Adapts to changes in the work

environment

-Successfully manages competing

demands

-Balances team and individual

responsibilities
JUDGMENT/DECISION-
MAKING
-Makes appropriate decisions in a
timely fashion

-Exhibits sound and accurate

judgment

-Support and explains reasons

behind decisions

-Includes appropriate people in

decision-making

INITIATIVE
-Seeks opportunities for self-
development, including increased
responsibilities

-Identifies problems and attempts

to resolve in early stages

-Volunteer readily

TEAMWORK
-Exhibits objectivity and openness
to the views of others

-Offers assistance and support to

co-workers

-Contributes to building positive

team spirit and cohesiveness

-Displays an understanding of how

job relates to others

-Works cooperatively in group

problem-solving situations

-Works to actively resolve conflicts

CUSTOMER SERVICE
-Displays courtesy and sensitivity

-Manages difficult or emotional

customer situations

-Responds to customer needs

promptly; responds to requests for
service or assistance

-Establishes and maintains effective

relations

-Considers the perspectives of

diverse populations

COMPETENCIES/BEHAVIORS RATING (average): ________

 PART III – DEVELOPMENT PLAN
STRENGTHS: (manager to complete)
List significant strengths. Describe skills, knowledge, and behavior that contributed to good
performance.

AREAS FOR DEVELOPMENT: (manager to complete)

Describe the new or improved skills, knowledge, behavior required to improve or maintain performance.
Establish plan to accomplish improvements and include in goals for the next review period.

EMPLOYEE COMMENTS:
Suggestions for work improvement:

How can your supervisor assist in achieving future goals?

Other items you’d like to discuss:

Signature indicates that the contents of this form were discussed. It does not indicate agreement or
disagreement.
__________________________________
Employee’s signature Date
__________________________________ ___________________________________________
Manager’s signature Date Approval By (Next Level of Management) Date
 PART IV – CURRENT JOB DESCRIPTION
JOB TITLE: Clinical Pharmacist REPORTS TO: Director of Pharmacy

JOB PURPOSE
To provide specialized pharmaceutical services including advising physicians on matters pertaining to
drug usage and control within assigned hospital locations.

MINIMUM REQUIREMENTS
Educational/Knowledge Requirements: Doctor of Pharmacy degree
Residency Training in clinical specialty area
Licensure/Certification: Florida Pharmacist License; Board Certification in clinical specialty area
RESPONSIBILITIES
Provide specialized pharmaceutical services including advising physicians on matters pertaining to drug
usage and control within assigned hospital locations.

Coordinate the activities of pharmacy technicians and pharmacy interns engaged in the preparation,
labeling and delivery of medications and other pharmaceutical supplies in accordance with physicians'
prescriptions

Ensure compliance with federal, state and local laws and regulations pertaining to the dispensing of
drugs and controlled drugs and the maintenance of required records.

Conduct and evaluate medication histories, assess compliance and suggest modifications so as to
achieve desired outcomes; instruct patients in the proper use of prescribed drugs and make Patient
Care Rounds with physicians to evaluate patient progress.

Individualize medication regimens using sound principles, accounting for pharmacodynamic and
pharmacokinetic variations in drug absorption, distribution, metabolism and elimination with
responsibility for establishing and continually improving the delivery of Pharmaceutical Care to
patients within areas of direct responsibility and assisting others in the department with the same.

Maintain liaison relationships with medical and nursing staff; provide timely information pertaining to
pharmaceutical supplies, drug usage and compatibility, state and federal regulations regarding drug
controls, and Joint Commission Standards.

Mentor pharmacists in training including, but not limited to, pharmacy residents and pharmacy
students; activities should include both practical and didactic experiences.

Participate in the development and delivery of in-services and continuing education programs for
Pharmacy, Patient Care Services, Medical staff, and students.

Conducting and participating in research including, but not limited to, performing as the primary
investigator or co-investigator for research programs which will impact on the delivery of quality care.

The above statements describe the general nature and level of work being performed by individuals
assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and
duties required of personnel so classified.
Employee Signature___________________________________ Date: _______________

*taken from Duke University Clnical Pharmacist description: http://www.hr.duke.edu/jobs/job_descriptions/campus/select.php?ID=1642

 PERFORMANCE RATINGS AND CORRESPONDING MERIT PAY INCREASES FOR
FISCAL YEAR (FY) 2015

Average Merit Adjustment Rounded

Overall Description 2015 Performance Rating
Rating
1.00 to 1.49 Does not meet most requirements 0.00% 1
for position
1.50 to 1.99 Meets some, but not all 1.00 to 2.25% 2
expectations
2.00 to 2.24 Good performance, meets 2.25% to 2.50% 2
expectations
2.25 to 2.49 Strong performance, exceeds some 2.50% to 3.00% 2
expectations
2.50 to 2.74 Superior performance, exceeds 3.00% to 3.25% 3
majority of expectations
2.75 to 3.00 Excellent performance, consistently 3.25% to 3.50% 3
demonstrates excellence and
serves as an example to others

Example Calculation:

Part I – Goals 2.00

Part II – Competencies 2.25
Total Score 4.25
Divided by 2 = 2.13
Merit Increase per guidelines : = 1.00% to 2.25%
Overall Performance Rating (rounded): =2

(Previous year, Charlie was given a score of 1.99 for meeting some, but not all expectations and a 2.25%
raise.)