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Note: The purpose of the self assessment is to give the employee an opportunity to
objectively think about his/her own performance and to provide information to the manager to
assist in an accurate performance review. In addition, the self assessment provides an
opportunity for open communication about the employee’s performance during the
performance discussion session.
Performance Against Key Performance Indicators (on Supervisor/Manager and Office Professional
forms only)
5) List each objective that was established for the employee to concentrate on during the review
period. If none currently exist take from duties listed in Job Description or Agree at the beginning of
the process 5 Key indicators rlated to the performance of the position which the employee occupies.
6) Beside each objective, indicate a descriptor that best suits your performance of those objectives
Key Performance Indicators for next review period (on Supervisory/Professional forms only)
7) Identify 5 Key Performance Indicators that you think are important for your position for the next
review period.
9) Support your Overall Rating Score with examples of your performance in the Comments Section
to
Performance What This Means to Does not meet Sometimes Exceeds Continuously Exceeds
Category Total Safety Score Requirements Needs Improvement Meets Expectations Expectations Expectations
Quality is the fiber that binds all of our Continuously seeks ways to
efforts around the globe. Total Safety's Occasionally meets Consistently meets improve productivity and
Lets project details slip; Maintains a persistent focus on
reputation is built on the quality of service objectives; Reports objectives; Follows work effectiveness; Proactively raises
Consistently provides quality as well as on results;
we provide. Our goal is to provide high- sometimes have errors; processes; Notices critical issues that impact quality
2 Quality quality safety solutions in a measurable,
incorrect data causing
Occasionally lacks attention mistakes in his or her own
Helps to determine how to
and takes the lead in resolving
problems for others who improve productivity and
cost-effective manner, without to the critical issues and work and takes corrective them; Encourages others to suggest
depend on that information effectiveness
compromise. details action improvements
Please Choose Evidence Required
Rating
Lays blame, points fingers, Works well as part of a team Respects and responds to others’
Doesn't always follow Is able to work across
scrutinizes other members; and shares ideas and ideas and opinions; Builds on the
through on commitments workgroups; Shares information
Our teamwork enables us to lead the Does not give credit to information; Puts forth suggestions of team members;
and generally doesn't as appropriate; Fills in for
industry. We work well as part of a team teammates; Does not additional effort when Encourages the exchange of
Teamwork support the team when teammates and takes
4 and share ideas and information. We support team decisions, nor
additional work is needed;
necessary to help team
ownership as if tasks were their
productive ideas; Helps resolve
establish positive working relationships contribute to the team; Does reach goals; Maintains a team conflicts; Adjusts own actions
Does not readily share all own; Looks for additional ways
throughout the organization. not volunteer for positive attitude toward and approach as necessary to help
relevant information with to help out team; Seeks out
assignments; Does not peers and supervisors; Has the group achieve its goals
other team members other initiatives
participate in meetings a pitch-in attitude Evidence Required
Please Choose
Rating
1
Please Choose Rating
2
Please Choose Rating
3
Please Choose Rating
4
Please Choose Rating
5
Please Choose Rating
EVALUATION RATING
Development Opportunities
Identify areas for development during the next review period.
Identify competencies that you would like to improve and in what way. Include what training and learning opportunities you would like to have:
What obstacles are in the way of you achieving your performance objectives? What are you planning to overcome these obstacles? What actions can your Supervisor and/or the
Company take to help remove these inhibitors?
Signature
Employee Date