Certified Exempt & Support Staff Evaluation Form

Evaluation Process Outline
Printable PDF of SELF-REFLECTION Form
Hoja de auto-Evaluación para el Personal de Apoyo

Supervisors - Use this form to complete evaluations for your employees. Once you submit this form, two things will happen:

The Evaluation Form will be emailed to you so you can print it and obtain the necessary signatures.
The Evaluation Form will be sent to Human Resources.

Employees - Use this form to complete your Self-Reflection, which is the first step to finalizing your annual job performace evaluation. Once you complete this form, two things will happen:

The Self-Reflection Form will be emailed to you so you can print or save it.
The Self-Reflection Form will be emailed to your supervisor.

I am... *

a supervisor submitting an employee evaluation form.

an employee submitting a self-reflection form.

Employee *

Employee Email

School

Department

School or Department

Job Title *

Supervisor *

Supervisor Email *

use this link to lookup the supervisor email address

Job Performance

40% of overall evaluation. Ability to effectively carry out essential job functions.

1) Performance *

(4) Is truly extraordinary.

(3) Exceeds requirements.

(2) Is fully competent and professional.

(1) Is below expectation of quality.

(0) Is totally unacceptable.

2) Self-Directed *

(4) Effectively self-manages.

(3) Requires little supervision or direction.

(2) Requires some supervision and direction.

(1) Requires frequent supervision and management.

(0) Requires constant supervision and micromanagement.

3) Professional Reputation *

(4) Recognized for excellence internally and externally.

(3) Respected internally and recognized for excellence.

(2) Seen by internal colleagues as fully competent.

(1) Seen by colleagues as needing development and improvement.

(0) Obstacle to quality and professionalism.

4) Value to the Organization *

(4) Is considered an elite talent.

(3) Is considered as a very high-quality employee.

(2) Is considered a professional.

(1) Is considered a work in progress.

(0) Is considered a possible candidate for termination.

Job Performance Average

Job Knowledge

20% of overall evaluation. Understanding critical elements of the job/information skills.

5) Positional Understanding *

(4) Commanding knowledge of the position including how it can operate in other organizations and configurations.

(3) Complete understanding of the position, along with demonstrated understanding of related positions.

(2) Full and professional understanding of the specific position.

(1) Incomplete understanding of position.

(0) No understanding.

6) Professional Development *

(4) Demonstrates acquisition of information to remain professionally competent in own position and other significant parts of the organization.

(3) Demonstrates acquisition of information to remain professionally competent in own and related positions.

(2) Demonstrates acquisition of information to remain professionally competent.

(1) Demonstrates acquisition of information to meet minimum job responsibilities.

(0) Demonstrates no desire to acquire new information.

7) Problem Solving Skills *

(4) Demonstrates problem solving and creativity that improves the entire organization.

(3) Demonstrates problem solving and creativity that improves the department or helps related positions function better.

(2) Demonstrates problem solving and creativity that helps the position function better.

(1) Demonstrates some problem solving related to the position that may or may not be relevant or beneficial.

(0) Demonstrates no problem solving ability or innovation.

8) Input that Improves the Organization *

(4) Provides quality, innovative input, and problem solving outside typical job responsibilities.

(3) Provides quality input and guidance from their professional perspective.

(2) Provides valuable input for organizational improvement.

(1) Provides some meaningful input for organizational growth that may or may not be relevant or beneficial.

(0) Provides no input.

Job Knowledge Average

Dependability/Reliability

20% of overall evaluation. Punctuality, attendance, and accuracy.

9) Productivity *

(4) Individual is in command of own responsibilities and placement and is able to assist others across the organization.

(3) Individual effectively handles own responsibilities and placement, and is able to assist others in regular tasks.

(2) Individual is where they are supposed to be and doing what they are supposed to do.

(1) Individual is occasionally missing from post or distracted, reducing productivity.

(0) Individual is frequently missing from post or off task.

10) Reliability *

(4) Rarely misses work and only in extreme/unusual circumstances.

(3) Plans effectively where only extreme/unusual circumstances affect scheduled work.

(2) Misses scheduled work rarely, and only when a legitimate personal issue/illness arises.

(1) Misses scheduled work occasionally to the point it impacts productivity.

(0) Regularly misses scheduled shifts completely.

11) Accuracy *

(4) Mistakes are very rarely made, if ever.

(3) Mistakes are rare, with little impact.

(2) Mistakes occur, but are infrequent and are not repeated.

(1) Mistakes are repeated and occasionally serious .

(0) Mistakes are frequent, major, and chronic.

12) Punctuality and Break Time *

(4) Without being asked, and when necessary, arrives before required start times and always stays to finish critical work. Puts the organization first when taking breaks.

(3) When needed, arrives on or before required start times, and stays until critical work is finished. Conscientious use of break time.

(2) Arrives and departs on time for work. Does not abuse breaks

(1) Is occasionally late to the point it impacts work or others. Has abused break time.

(0) Is frequently late for work. Abuses breaks habitually.

Dependability/Reliability Average

Organizational Representation

20% of Overall Evaluation. Personal choices that affect the job place, effective understanding and communication skills, and personal appearance.

13) Helpfulness *

(4) Suggests and/or creates systems to help others complete important tasks and organize essential workloads. Actively finds ways to help.

(3) Helps others complete important tasks and organize essential workloads in their own unit/department and in other parts of the organization. Steps in whenever needed.

(2) Provides assistance in helping others complete important tasks and organize essential workloads within their own unit/department.

(1) Must be directed to help others complete important tasks and organize essential workloads.

(0) Resistant to helping others with important tasks and organize essential workloads.

14) Demonstrates Initiative *

(4) Serves in a leadership capacity exceeding their job requirements. Continually works to understand and communicate the organization’s direction and focus.

(3) Regularly volunteers for additional duties and responsibilities and is a source of information about the organization’s direction and focus.

(2) When necessary takes on additional duties and responsibilities and stays current on the organization’s direction and focus.

(1) Avoids additional duties and responsibilities. Is unclear of the organization’s direction and focus.

(0) Refuses additional duties and responsibilities. Is indifferent about the organization’s direction and focus.

15) Interpersonal Communications *

(4) Employee demonstrates exceptional kindness, altruism, and empathy in listening and communicating with others.

(3) Employee goes out of their way to understand others and is always respectful.

(2) Employee is polite and kind in communicating with others.

(1) Employee is indifferent or irritated in communicating with others.

(0) Employee is rude in communicating with others.

16) Organizational Representation *

(4) Champions the organization.

(3) Advocates for the organization.

(2) Fairly represents the organization.

(1) Indifferent about representing the organization.

(0) Embarrasses the organization.

17) Strive to Understand and be Understood *

(4) Employee demonstrates that communication is a high goal and shows motivation to understand and be understood.

(3) Employee finds ways and time to understand and be understood.

(2) An effort is made to understand and be understood.

(1) Minimal effort is made facilitate understanding.

(0) No effort is made to facilitate understanding.

18) Chain of Command *

(4) The chain of command is understood and followed and the employee ensures others understand and follow as well.

(3) The chain of command is always understood and followed.

(2) The chain of command is generally followed.

(1) The chain of command is misunderstood and occasionally violated.

(0) The chain of command is intentionally ignored.

19) Appearance *

(4) Employee attire is impeccable for given work environment and serves as an example to others in the organization and community.

(3) Employee attire is conscientious, professional, and safe for given work environment. Personal appearance represents the organization in a positive way.

(2) Employee is appropriately and safely attired for work.

(1) Employee occasionally wears inappropriate or unsafe attire.

(0) Employee continually wears inappropriate or unsafe attire.

20) Ability to Work Collaboratively *

(4) Mediates and refocuses workers in dispute. Champions the rights of others as co-workers and people.

(3) Is positive and encouraging to other workers. Works to protect the rights of others as co-workers and people.

(2) Has a generally positive relationship toward other workers. Respects the rights of others as co-workers and people.

(1) Has been entangled with work or personal problems with other workers. Shows minimal respect for the rights of others as co-workers and people.

(0) Regularly involved with work or personal problems with other workers. Does not respect the rights of others as co-workers and people.

Organizational Representation Average

Final Score

Specific Reinforcement

Specific Refinement