Employee Self Evaluation

Name: __________________________________ Title: ___________________________________ My primary duties/responsibilities are: 1.________________________________________________________________________ 2.________________________________________________________________________ 3.________________________________________________________________________ 4.________________________________________________________________________ 5.________________________________________________________________________ My secondary work duties/ responsibilities are: 1.________________________________________________________________________ 2.________________________________________________________________________ My major work related strong points are: 1._________________________________________________________________________ 2._________________________________________________________________________ What were your major achievements/accomplishments in the past year? Date: ____________

Who are your primary customers and how well have you served them this past year?

What are the areas of your performance (behaviors & results) on which you could improve?

What personal/professional development activities have enhanced your performance or skill set?

Are there additional skills or knowledge that I could provide that would help you more effectively perform your present job or enhance your skill opportunities? If yes please list.

Communication: Effective use of listening skills and displaying openness to others thoughts and ideas; Effectively conveying information and expressing thoughts and facts. Keeping in mind the definition of communication, please answer the following: Your areas of success:

Your areas for development:

Customer /Quality Focus: Anticipating, monitoring, and meeting the needs of customers and responding to them in an appropriate manner. Demonstrating personal commitment to identify customers apparent and underlying needs and continually seeks to provide the highest quality services and products to your customers. Keeping in mind the definition of Customer Quality Focus, please answer the following: Your areas of success:

Your areas for development:

Initiative/Innovation/ Adaptability: Willingness to assume additional responsibilities; to develop and or pursue alternative or new concepts to help facilitate the achievement of Samenas mission and goals; and being able to acclimate to new situations. Keeping in mind the definition of Initiative/Innovation/Adaptability, please answer the following: Your areas of success:

Your areas for development:

Team Focus: Working cooperatively and effectively with others to achieve a common goal. Participating in building a group identity characterized by pride, trust, and commitment. Keeping in mind the definition of Team Focus, please answer the following: Your areas of success:

Your areas for development:

Accountability: Accepting responsibility for your own actions and decisions and demonstrates a commitment to accomplish work in an ethical, efficient and cost-effective manner. Keeping in mind the definition of Accountability, please answer the following: Your areas of success:

Your areas for development:

Community/Professional Relations: Fostering positive relationships and acting as a representative of Samena to external parties. Keeping in mind the definition of Community/Professional Relations, please answer the following: Your areas of success:

Your areas for development:

Inclusiveness: Fostering respect for all individuals and points of view; demonstrating a personal commitment to create a hospitable and welcoming environment. Keeping in mind the definition of Inclusiveness, please answer the following: Your areas of success:

Your areas for development:

Planning and Decision Making: Clarity in setting priorities, analyzing, organizing, and forecasting. It renders competent decisions that allow you to achieve the goals set for yourself and Samena. Keeping in mind the definition of Planning/Decision making, please answer the following: Your areas of success:

Your areas for development:

Leadership: Mentoring, motivating and guiding others toward their goals; Provides training and development maximizing the knowledge and skills of subordinates. Keeping in mind the definition of Leadership, please answer the following: Your areas of success:

Your areas for development:

We have discussed the staff members Self Assessment Staff Members Signature: ____________________________ Date: ______ Supervisors Signature _______________________________ Date: ______