EMPLOYEE PERFORMANCE APPRAISAL

Employee Name
Position/Title
Lab/Div or Prog
nationality

Does this position supervise others? Yes No

If yes, how many?. Total directly supervised:
Total indirectly supervised:

PART A: JOB-RELATED SKILLS AND COMPETENCIES: Select from the following list of relevant and
observable job-related skills and competencies and use them to describe how the employee performs
his/her job: Communication, Decision Making, Dependability, Initiative, Job Knowledge, Judgment,
Leadership, Planning, Problem Solving, Responsiveness to Constituents, Teamwork, and Work
Environment / Safety.

This section of the Performance Appraisal must be completed for employees who are new to their job.
This includes new hires or employees whose job has significantly changed since their last Performance
Appraisal. For other employees, this section is optional, but should be completed if there has been a
significant change in the employee’s skills or competencies.

Skills and Competencies Description of Employee's Level of Proficiency

PART B: PERFORMANCE OF KEY ACTIVITIES: List each Key Activity, in priority order, for which the
employee is responsible. For each Key Activity, discuss the employee's performance during the prior year
and recent years, as appropriate, and indicate any suggested changes or improvements needed for the
upcoming year. Employees who have been in their current position two years or more need not be
evaluated for ongoing, routine key activities if the employee’s performance continues to meet or exceed
job requirements. If the key activity or the employee’s performance level has changed significantly, the
performance for the activity must be evaluated.

For Supervisors, include the following Key Activities:

• Leadership (managing, training, developing, motivating, and coaching)
• Administration (managing budgets and priorities, performance management)

Encouragement of Diversity* for all employees:

List any activity that demonstrates an awareness of and commitment to a diverse/inclusive workforce, e.g.,
recruitment, mentoring, professional development, outreach and partnerships. *Note that this is an area
for acknowledgment and added value to the organization.
Key Activity:

Type:
Description of employee's Performance:

Suggested Changes or Improvements:

Key Activity:
Type:
Description of employee's Performance:

Suggested Changes or Improvements:

Key Activity:
Type:
Description of employee's Performance:

Suggested Changes or Improvements:

Key Activity:
Type:
Description of employee's Performance:

Suggested Changes or Improvements:

Key Activity:
Type:
Description of employee's Performance:

Suggested Changes or Improvements:

Key Activity:
Type:
Description of employee's Performance:

Suggested Changes or Improvements:

PART C: COACHING AND DEVELOPMENTAL PLANNING: Identify opportunities for professional growth.
Also list any specific goals which the employee is expected to accomplish. Where possible, state specific
action items and timelines for the accomplishment of them.

Goal Specific Action Timeframe

1)
2)
3)
4)
5)

PART D: OVERALL PERFORMANCE: Consider the Job-Related Skills and Competencies and all Key
Activities (as well as the relative importance of each) to decide the overall rating. Please check one of the
two ratings noted below:

Performance Meets or Performance Does Not

Exceeds Job Requirements Meet Job Requirements

Provide a brief summary of the employee's overall performance for the past year:

Employee Comments:

I have had the opportunity to read and discuss this appraisal with my supervisor. (Signature does not
imply agreement or disagreement.)

Employee Signature: ______________________________________________Date:__________

Appraisal Completed by (Supervisor): __________________________________Date:_________

Approved by Laboratory or Program Director: ______________________ Date:_________

Conflict of Interest Statement
All employees must complete this Conflict of Interest Statement upon hire and update the
Statement at least once a year. Employees must immediately notify the UCAR Ethics Officer of
any matters that may result in real or apparent conflicts of interest by submitting a Conflict of
Interest Statement through their chain of authority, including the relevant UCAR/UCP Program
director and the appropriate member(s) of the President's Council.

Outside employment that creates a conflict of interest, or the appearance of such must be
declared on this Conflict of Interest Statement.

(Reference UCAR Conflict of Interest Policy and Procedures.)

Name:_________________________________ Date:_________________
(Please Print)

1. Do you have an outside job that may create a conflict of interest with your employment.

No__ Yes__ Please explain:________________________________________

______________________________________________________________________________
______________________________________________________________________________
____________________________________
________________________________________________________________

2. Do you have any other conflict of interest with your employment at UCAR?

No__ Yes__ Please explain:________________________________________

______________________________________________________________________________
______________________________________________________________________________
____________________________________
________________________________________________________________

Additional sheets may be added if needed.

Signature:___________________________________ Date:_______________

June 7, 2011