Form Preview - Dental Health Services Portal

Employee Name

Job Title

Department

Time in Position

Date of Last Review

Review Date

Date Hired

Period Covered by Review

From:

Period Covered by Review

From:

Period Covered by Review

From:

Period Covered by Review

From:

Period Covered by Review

From:

Period Covered by Review

From:

Period Covered by Review

From:

Period Covered by Review

From:

Period Covered by Review

From:

Period Covered by Review

To:

Period Covered by Review

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Period Covered by Review

To:

Period Covered by Review

To:

Period Covered by Review

To:

Reason for Review

Annual

End of Introductory Period

Reason for Review

Annual

End of Introductory Period

Reason for Review

Annual

End of Introductory Period

Reason for Review

Annual

End of Introductory Period

Reason for Review

Annual

End of Introductory Period

Purpose of Review

The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Purpose of Review

The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Purpose of Review

The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Purpose of Review

The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Carefully evaluate employee\\\'s work performance in relation to the essential functions of the job. Check the rating box that best indicates employee\\\'s performance. Assign points for each rating within the scale and write that number in the corresponding points box. Points will be totaled and averaged for an overall performance score.

Definitions of Performance Ratings (to be used in rating on the following pages)

(5) O-Outstanding- Performance is exceptional in all areas and is recognizable as being far superior to others. (4) V-Very Good- Results clearly exceed most position requirements. Performance is of high quality and is achieved on a consistent basis. (3) G- Good - Competent and dependable level of performance. Meets the performance standards of the job. (2) I- Improvement Needed - Performance is deficient in certain areas. Improvement is necessary. (1) U- Unsatisfactory- Results are generally unacceptable and require immediate improvement. No Merit increase should be granted to individuals with this rating.

Definitions of Performance Ratings (to be used in rating on the following pages)

I. Performance Factors

A. Professional Skills

I. Performance Factors

A. Professional Skills

I. Performance Factors

A. Professional Skills

I. Performance Factors

A. Professional Skills

I. Performance Factors

A. Professional Skills

Job Knowledge: Possess working knowledge of all phases of the job and the various techniques and skills necessary for efficient completion of tasks. Remains up to date on changes/trends in technical knowledge related to job. Expands knowledge of the job and company services as it relates to other positions.

Minimum Value: 1, Maximum Value: 5

Comments:

Job Knowledge: Ability to make sound and proper decisions by drawing on professional expertise with minimal negative effects of employee relations and/or departmental and company goals and results. Willingness to take responsibility for these decisions.

Minimum Value: 1, Maximum Value: 5

Comments:

B. Interactive Skills

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.

Minimum Value: 1, Maximum Value: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.

Minimum Value: 1, Maximum Value: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.

Minimum Value: 1, Maximum Value: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.

Minimum Value: 1, Maximum Value: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.

Minimum Value: 1, Maximum Value: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.

Minimum Value: 1, Maximum Value: 5

Comments:

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.

Minimum Value: 1, Maximum Value: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.

Minimum Value: 1, Maximum Value: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.

Minimum Value: 1, Maximum Value: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.

Minimum Value: 1, Maximum Value: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.

Minimum Value: 1, Maximum Value: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.

Minimum Value: 1, Maximum Value: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.

Minimum Value: 1, Maximum Value: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.

Minimum Value: 1, Maximum Value: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.

Minimum Value: 1, Maximum Value: 5

Comments:

C. Administrative Skills

1. Coordination: Ability to work with others as a team and express individual viewpoint while considering and learning from the input of others.

Minimum Value: 1, Maximum Value: 5

1. Coordination: Ability to work with others as a team and express individual viewpoint while considering and learning from the input of others.

Minimum Value: 1, Maximum Value: 5

1. Coordination: Ability to work with others as a team and express individual viewpoint while considering and learning from the input of others.

Minimum Value: 1, Maximum Value: 5

1. Coordination: Ability to work with others as a team and express individual viewpoint while considering and learning from the input of others.

Minimum Value: 1, Maximum Value: 5

Comments:

2. Planning and Organization: Establishes appropriate course of action for self and subordinates to accomplish goals. Makes proper assignments of personnel and appropriate use of resources. Sets realistic target dates.

Minimum Value: 1, Maximum Value: 5

Comments:

3. Adherence to Policies and Procedures: Properly interprets and applies company and departmental policies and procedures to job responsibilities.

Minimum Value: 1, Maximum Value: 5

3. Adherence to Policies and Procedures: Properly interprets and applies company and departmental policies and procedures to job responsibilities.

Minimum Value: 1, Maximum Value: 5

3. Adherence to Policies and Procedures: Properly interprets and applies company and departmental policies and procedures to job responsibilities.

Minimum Value: 1, Maximum Value: 5

3. Adherence to Policies and Procedures: Properly interprets and applies company and departmental policies and procedures to job responsibilities.

Minimum Value: 1, Maximum Value: 5

Comments:

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.

Minimum Value: 1, Maximum Value: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.

Minimum Value: 1, Maximum Value: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.

Minimum Value: 1, Maximum Value: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.

Minimum Value: 1, Maximum Value: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.

Minimum Value: 1, Maximum Value: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.

Minimum Value: 1, Maximum Value: 5

Comments:

II. Performance Expectations

List and comment on four major performance expectations you had for the employee during the current review period. Specify how well the employee supported.reached your expectations. Consider quality, quantity and impact on department objectives and operating results.

II. Performance Expectations

1. Performance Expectation

Supervisors Comments:

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

1. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

2. Performance Expectation

Supervisors Comments:

2. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

2. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

2. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

2. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation

Supervisors Comments:

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

3. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

4. Performance Expectation

Supervisors Comments:

4. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

4. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

4. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

4. Performance Expectation:

Minimum Value: 1, Maximum Value: 5

III. Rate Overall Performance

Total Points/Number of Factors Rated= Overall Rating

III. Rate Overall Performance

Total Points/Number of Factors Rated= Overall Rating

III. Rate Overall Performance

Total Points/Number of Factors Rated= Overall Rating

III. Rate Overall Performance

Total Points/Number of Factors Rated= Overall Rating

This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight: , Total: 0

Total Grade: 0

This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight: , Total: 0

Total Grade: 0

This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight: , Total: 0

Total Grade: 0

This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight: , Total: 0

Total Grade: 0

This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight: , Total: 0

Total Grade: 0

IV. Accomplishments and Contributions

Describe the accomplishments and contributions the employee made during the review period in areas other than those covered by specific objectives.

V. Major Strengths

Describe at least 3 major employee strengths.

VI. Areas Needing Improvement

Describe any areas needing improvement.

VII. Training and Development

What training or development activities should be considered during the next review period?

Discussed with individual on:

Follow-up requested/desired:

Yes

Follow-up requested/desired:

Yes

Follow-up requested/desired:

Yes

Follow-up requested/desired:

Yes

Follow-up date

Additional Employee Comments

Performance Objectives

List (in order of importance) five specific objectives you would like the employee to complete by the next review date. Describe in detail the action plan needed to reach the desired goals.

Form Authors: 0/0

Form Signers: 0/0

This report will be visible to Subject when all authors/signers are finished.

Annual Performance Review (BID) Of Subject

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