ROGATIONIST ACADEMY

ANNUAL EMPLOYEE SELF-ASSESMENT

PERFORMANCE EVALUATION
Comprehensive Form

EMPLOYEE NAME (FIRST, MI, LAST):                                                   

EMPLOYEE #:         YEARS OF SERVICE:         AGE:      

PRIMARY DESIGNATION:          SECONDARY DESIGNATION:          

PERIOD OF EVALUATION: From:        TO:       

_______________________________________________________________________________
PART I - INSTRUCTIONS TO EMPLOYEE
Listed below are five performance factors, seven behavioral traits, and five supervisory factors that are
important in the performance of the employee’s job. Performance factors and behavioral traits must be
utilized for all employees. The supervisor factors should be utilized only for employees with supervisory
responsibilities. NOTE: A rating of Unacceptable (1), Needs Improvement (2) or Superior (5) requires
comments. The “overall performance” evaluation should reflect the employee’s total performance, including
the performance factors as related to the employee’s responsibilities and duties as set forth in the job
description, behavioral traits and supervisory factors, if applicable.
1. Return the original form to Human Resource
DISTRIBUTION 2. Maintain one copy for your departmental records.
INSTRUCTIONS 3. Distribute one copy to the employee.

1. The supervisor should indicate the employee’s performance by

MARKING
using check box next to the appropriate level of
INSTRUCTIONS performance.

The following rating scale guide is being provided to assist the evaluator in assigning the most appropriate
measurement of the employees’ performance factors, behavioral traits and supervisory factors.

1= UNACCEPTABLE - Consistently fails to meet job requirements; performance clearly below minimum
requirements. Immediate improvement required to maintain employment.
2= NEEDS IMPROVEMENT – Occasionally fails to meet job requirements; performance must improve to
meet expectations of position.
3= MEETS EXPECTATIONS – Able to perform 100% of job duties satisfactorily. Normal guidance and
supervision are required.
4= EXCEEDS EXPECTATIONS – Frequently exceeds job requirements; all planned objectives were
achieved above the established standards and accomplishments were made in unexpected areas
as well.
5= SUPERIOR – Consistently exceeds job requirements; this is the highest level of performance that
can be attained.
PART II - PERFORMANCE FACTORS
Knowledge, Skills, Abilities – Consider the degree to which the employee exhibits the required level
of job knowledge and/or skills to perform the job and this employee’s use of established techniques,
materials and equipment as they relate to performance.

Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

      

       

1. Quality of Work – Does the employee complete assignments meeting quality standards?
Consider accuracy, neatness, thoroughness and adherence to standards and safety rules.
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

2. Quantity of Work – Consider the results of this employee’s efforts. Does the employee
demonstrate the ability to manage several responsibilities simultaneously; perform work in a
productive and timely manner; meet work schedules?
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:       

       

       

3. Work Habits – To what extent does the employee display a positive, cooperative attitude
toward work assignments and requirements? Consider compliance with established work
rules and organizational policies.
Unacceptable................................................................Superior
1 2 3 4 5

Comments:        

       

       

4. Communication – Consider job related effectiveness in dealing with others. Does the
employee express ideas clearly both orally and in writing, listen well and respond
appropriately?
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

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 5. Knowledge – Consider if the employee understands job functions, requirements, tools, and
processes associated with this position.
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

6. Problem Solving – Consider if when posed with a problem the employee has the ability to
develop timely solutions with alternatives.
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

7. Execution – Consider if the employee has the ability to ‘get things done’. Follows through
on tasks/projects until completion, completes tasks/projects in a timely manner and
according to schedule, overcomes obstacles, proposes solutions rather than excuses.
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

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PART III - BEHAVIORAL TRAITS
1. Dependability – Consider the amount of time spent directing this employee. Does the
employee monitor projects and exercise follow-through; adhere to time frames; is on time for
meetings and appointments; and responds appropriately to instructions and procedures?
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

2. Cooperation – How well does the employee work with co-workers and supervisors as a
contributing team member? Does the employee demonstrate consideration of others;
maintain rapport with others; help others willingly?
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

3. Initiative – Consider how well the employee seeks and assumes greater responsibility,
monitors projects independently, and follows through appropriately.
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

4. Adaptability – Consider the ease with which the employee adjusts to any change in duties,
procedures, supervisors or work environment. How well does the employee accept new ideas
and approaches to work, respond appropriately to constructive criticism and to suggestions
for work improvement?
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

5. Judgment – Consider how well the employee effectively analyzes problems, determines
appropriate action for solutions, and exhibits timely and decisive action; thinks logically.
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        
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6. Attendance – Consider number of absences, use of annual and sick leave in accordance with
School policy.
Unacceptable Acceptable

Comments:        

       

       

7. Punctuality – Consider work arrival and departure in accordance with departmental and
School policy.
Unacceptable Acceptable

Comments:        

       

       

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PART IV – COMMUNICATION AND INTERPERSONAL SKILLS
1. Verbal – Consider the employee’s ability to communicate clearly and effectively to others
through verbal communication, especially in the English language.

Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

2. Technical Writing – How well does the employee create technical documents which adhere to
corporate standards, clearly communicates technical details, and presented in an organized
manner?
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

3. Creative Writing –Consider the employee’s ability to influence readers through creative writing
resulting in a change in perception of value, urgency, quality, or other abstract qualities.
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

4. Influence – Consider the employee’s ability to influence others through effective

communication (verbal, written, illustrative, etc.).
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

5. Presentation – Consider the Quality, clarity, and effectiveness of presentations.

Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

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 6. Listening – Consider the employee’s ability to listen to and understand others, including the
practice of active listening.

Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

7. Interaction with Coworkers – How well does the employee work well with co-workers, respects
others, and has the respect of others?
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

8. Interaction with Supervisors – Works well with Superiors and Supervisors, respects their
authority and interacts in a professional manner.
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

9. Interaction with Clients – Works well with Clients (Students and Parents) resulting in
established and committed relationships with the clients.
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

10. Motivational Skills – Ability to motivate others which results in the desired outcome
(perform a task, change of attitude, etc.)
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

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PART V - SUPERVISORY FACTORS (IF APPLICABLE)
1. Leadership – Consider how well the employee demonstrates effective supervisory abilities;
gains respect and cooperation; inspires and motivates subordinates; directs work group
toward common goal.
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

2. Delegation – How well does the employee demonstrate the ability to direct others in
accomplishing work; effectively select and motivate staff; define assignments; oversee the
work of subordinates?
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

3. Planning and Organizing – Consider how well the employee plans and organizes work;
coordinates with others, and establishes appropriate priorities; anticipates future needs;
carries out assignments effectively.
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

4. Administration – How well does the employee perform day-to-day administrative tasks;
manage time; administer policies and implement procedures; maintain appropriate contact
with supervisor and utilize funds, staff or equipment?
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

       

5. Personnel Management – Consider how well the employee serves as a role model; provides
guidance and opportunities to their staff for their development and advancement; resolves
work-related employee problems; assists subordinates in accomplishing their work-related
objectives. Does the employee communicate well with subordinates in a clear, concise,
accurate, and timely manner and make useful suggestions?
Unacceptable.........................................................................Superior N/A
1 2 3 4 5

Comments:        

       

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PART VI – REVIEW OF GOALS/OBJECTIVES/SPECIAL ASSIGNMENTS FOR
THE PAST YEAR (IF APPLICABLE)
Where goals, objectives, projects, special assignments, etc. have been clearly established, progress
of these tasks should be evaluated. List and evaluate progress made on major pre-determined
goals, objectives, projects, and special assignments by marking the appropriate box. The
“Comments” space may be used for satisfactory progress but must be used for unsatisfactory
progress. Attach additional sheets if necessary.

1. Goal/Objective/Project/Special Assignment

       

       

       

       

Accomplished or Satisfactory Progress Unsatisfactory Progress (See “Comments” Below)

2. Goal/Objective/Project/Special Assignment

       

       

       

       

Accomplished or Satisfactory Progress Unsatisfactory Progress (See “Comments” Below)

3. Goal/Objective/Project/Special Assignment

       

       

       

       

Accomplished or Satisfactory Progress Unsatisfactory Progress (See “Comments” Below)

4. Goal/Objective/Project/Special Assignment

       

       

       

       

Accomplished or Satisfactory Progress Unsatisfactory Progress (See “Comments” Below)

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PART VII - OVERALL PERFORMANCE
Please use this space to describe the overall performance rating. The overall rating
should be a reflection of the performance factors, behavioral traits and supervisory
factors.
Unacceptable............................................................................Superior
1 2 3 4 5

Comments:        

       

       

SIGNATURES

Rater: _____________________________________________ Date:____________________

Rater’s Name (print): _________________________________

Reviewer: __________________________________________ Date:____________________

Rector: ____________________________________________ Date:____________________

Comments:        

       

       

PART VIII - TO THE EMPLOYEE:

I have been advised of my performance ratings. I have discussed the contents of this
review with my supervisor. My signature does not necessarily imply agreement. My
comments are as follows (optional) (attach additional sheets if necessary):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Signature: __________________________________________ Date:____________________

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APPENDIX 1: ADDITIONAL COMMENTS, INFORMATION,NOTES AND
WRITTEN REPORTS ON THE EMPLOYEE
Write below additional information that the rater believes that are important to be considered but
are not covered by the questions above. The rater may also use this space as narration support
to any of the evaluations written above.

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

Supervisor’s Signature: ______________________________ Date:____________________

Employee’s Signature: _______________________________ Date:____________________

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APPENDIX 2: ESTABLISHMENT OF GOALS/OBJECTIVES/SPECIAL
ASSIGNMENTS FOR THE COMING YEAR (IF APPLICABLE)
List below the goals, objectives, projects, or special assignments which should be continued
and/or completed in the coming year. It is understood that these goals, objectives, etc. are
subject to adjustment or change as situations and priorities change. This section should be
detached and kept in departmental files so that it can be updated as the situation warrants and so
that it can be used to assist the rater at the end of the next evaluation period. Attach a copy of
this completed form to the performance evaluation.

GOALS/OBJECTIVES/PROJECT/SPECIAL ASSIGNMENTS

1.       

       

       

       

2.       

       

       

       

3.       

       

       

       

4.       

       

       

       

5.       

       

       

       

6.       

       

       

       

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 7.       

       

       

       

8.       

       

       

       

9.       

       

       

       

10.       

       

       

       

Supervisor’s Signature: ______________________________ Date:____________________

Employee’s Signature: _______________________________ Date:____________________

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