University of Pittsburgh

STAFF SELF-APPRAISAL FORM

Employee Name (Last, First, Middle Initial) Employee Title Employee Department Supervisor Name Supervisor Title Self-Appraisal Date

STATEMENT OF PHILOSOPHY
T e Self-Appraisal provides you !it t e opportunity to "ontri#ute si$nifi"antly to improvin$ #ot your o!n performan"e and your !or%in$ relations ip !it your supervisor& T e 'niversity(s )erforman"e Appraisal )ro$ram is desi$ned to provide time for t e employee and supervisor to loo% #a"% over t e past and realisti"ally plan for t e future& T e self-appraisal en"oura$es you to #e proud of your a""omplis ments and "andid a#out your areas of improvement& T e follo!in$ *uestions are intended to elp you or$ani+e your t ou$ ts and s are information !it your supervisor prior to re"eivin$ your performan"e appraisal& An essential $oal of t e performan"e appraisal meetin$ is t at #ot you and your supervisor %no! "learly ! at you e,pe"t of ea" ot er and feel stron$ly t at you "an a" ieve your o#-e"tives #y !or%in$ to$et er& Instructions for completing this form Employees s ould respond to ea" of t e *uestions "ompletely and a""urately& Employees s ould "omplete t is form prior to the !nnu!l perform!nce !ppr!is!l meeting !it t eir supervisor& Employees s ould provide t eir supervisor a "opy of t is "ompleted form prior to t eir performan"e appraisal meetin$&

"# $escri%e &our most signific!nt !ccomplishments this p!st &e!r#

'# $escri%e !n& %!rriers or ch!llenges th!t imp!cte( &ou in effecti)el& completing &our *o% responsi%ilities or !ccomplishing &our go!ls#
Form #0040 Self Appraisal - Revised April 1, 2012

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University of Pittsburgh

+# Ple!se list &our !re!,s- of strength !n( !re!,s- of impro)ement#

.# /h!t s0ills or ne1 0no1le(ge 1oul( &ou li0e to (e)elop to impro)e &our perform!nce2

3# Is there !n& other inform!tion &ou 1oul( li0e to sh!re 1ith &our super)isor reg!r(ing &our 1or0 perform!nce2

Emplo&ee Sign!ture4$!te )rint Name.

Super)isor Sign!ture4$!te )rint Name.

Note Super)isor sign!ture )erifies th!t the super)isor h!s re!( the contents of this (ocument !n( it (oes not necess!ril& impl& !greement 1ith the contents#

Form #0040 Self Appraisal - Revised April 1, 2012

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