Work schedules:

1. Distribution of Evaluation Form to concern Subordinates: 18th of Shrawan,

2075
2. Completion of Evaluation by Appraiser/Peer within: 28th of Shrawan,
2075
3. Completion of Evaluation by Reviewer and submission to Admin last date: 5th of Bhadra, 2075
4. Call Management Meeting for finalization of PLI within: 18th of Bhadra, 2075
5. Distribution of letter to individual staff through Supervisors by: 25th of Bhadra, 2075

Note:

All Supervisors and Reviewers are kindly requested to evaluate each and every staff
for making fair evaluation neither strong nor loyal. It should be specially based on
actual work performance, so that we can have a best result of overall evaluation of
the F.Y. 2074/75. We also like to request to all supervisors for necessary
consultation with the earlier supervisors as well of the staff who has evolved more
than single project. Thanks.

Performance Evaluation Form

B. For Officer Cadre

Appraisal Period FY:

Name Designation
Function/ Project/ Unit Location
Name of Appraiser Designation
Name of Reviewer Designation

Target Vs. Achievements Evaluation

S.N. Targets Achievements* A (40%)
Agreed Objectives W Self Appraiser Reviewer
(%) (25%) (50%) (25%)
1 10
2 10
3 10
4 10
5 10
6 10
7 10
8 10
9 10
10 10
Total 100
%
Average (0.25*self-total+0.5*Appraiser total+0.25*
Reviewer Total)

Appraisee: Appraiser: Reviewer:

Signature Signature Signature

Note:
 To be filled in briefly by the Appraisee
 Appraiser and Reviewer must be at least immediate supervisor.
 Comments, if any, can be written in comments and recommendation section of this form.
Attributes Evaluation

SN Criteria Score Remarks

Weightage Appraiser Reviewer
1 Quality output 10
2 Job Knowledge/versatility 14
3 Cost consciousness and Time 10
management
4 Punctuality/Neatness 10
5 Interpersonal skills and Communication 6
skills
6 Decision making ability 10
7 Executive Maturity 10
8 Customer orientation & responsiveness 8
9 Adaptability to Change 10
10 Competence for higher responsibility 12
and Discharge of additional
responsibilities
Total 100

Appraisee: Appraiser: Reviewer:

Signature Signature Signature:

Final Score By the Reviewer

Score Weighta Total
ge
Targets Vs. Achievements (Average of 3 40%
ratings above)
Attributes Evaluation by Appraiser 40%
Attributes Evaluation by Reviewer 15%
Attributes Evaluation by Peer (Format in next 5%
page)
Total (Out of 100):
Rating*:

Date: ___________
Signature
* Rating
Poor Satisfactory Good Very Good Excellent Outstanding
Below 50% 50% -64.99% 65% to 74.99% 75% to 85% to More than
84.99% 94.99% 95%

360 degree feedback survey for Appraisee by the peer

Name of Appraisee: Function/Project unit:

Appraisee’s Title: Performance Period:

FROM TO
Use the following scale to evaluate the Appraisee his or her on-the-job behaviours. Please
Mark √ in appropriate box.

Strongly Agree: This is an exceptional area of skill of the Appraisee. S/he is extremely
effective in this area and clearly demonstrates a special knowledge, skill
and/or capacity.

Agree: The Appraisee has an appropriate and effective level of proficiency in this
area. S/he possesses and demonstrates the necessary skill, knowledge
and/or capacity.

Neither Agree nor The Appraisee is rated as the average in possessing and demonstrating
the necessary skill knowledge and/or capacity.

Disagree: The Appraisee needs improvement in this area. S/he should work to become
more effective in this area and reach a higher level of proficiency.

Strongly Disagree: The work environment is significantly affected by Appraiser’s lack of skill
in this area.
 ATTRIBUTES

Agree
Strongly

Agree

Disagree
Agree nor
Neither

Disagree

Disagree
Strongly
S.
N

My Peer gives useful, developmental feedback to

1 5 4 3 2 1
others.
My Peer recognizes and praises others when they do
2 5 4 3 2 1
especially good work.
My Peer stays current on new developments in the
3 5 4 3 2 1
area of his/her supervision.
My Peer understands the Division's policies and
4 5 4 3 2 1
practices and uses them effectively.
My Peer gives timely, constructive feedback to
5 5 4 3 2 1
others on their work, ideas, and other contributions.
My Peer considers others’ ideas and shows
6 5 4 3 2 1
understanding for what they are communicating.
My Peer actively promotes cooperation, teamwork,
7 5 4 3 2 1
and collaborative problem solving.
8 My Peer communicates openly and honestly. 5 4 3 2 1
9 My Peer treats others fairly and consistently. 5 4 3 2 1

My Peer cultivates good working relationships with

10 people inside and outside the Division and utilizes 5 4 3 2 1
these networks to accomplish important goals.

My Peer presents logical and compelling cases for

11 5 4 3 2 1
his/her arguments.

My Peer seeks to understand and incorporate others’

12 5 4 3 2 1
viewpoints and perspectives.
13 My Peer adjusts well when things change. 5 4 3 2 1
My Peer initiates changes that he/she thinks would
14 5 4 3 2 1
be beneficial.

15 My Peer demonstrates trust and respect for others. 5 4 3 2 1

16 My Peer follows through on his/her commitments. 5 4 3 2 1

My Peer readily acknowledges his/her own mistakes,

17 limitations, and/or failures - never looks for others to 5 4 3 2 1
try and blame for his/her own mistakes.
 My Peer never takes credit for others’
18 5 4 3 2 1
accomplishments and successes.
My Peer demonstrates consistency between his/her
19 5 4 3 2 1
words and actions.
My Peer acts ethically and with high integrity when
20 5 4 3 2 1
making decisions.
Total

OPTIONAL:
To maintain effectiveness, the Appraisee should CONTINUE TO:

To increase effectiveness, the Appraisee should BEGIN TO:

To increase effectiveness, the Appraisee should STOP:

Name of the Peer:

Signature: Date:
Comments/Recommendations
SN Area Comments/Recommendations (In Order of Priority)
Appraiser Reviewer
1 Job Rotation

2 Training

3 Assignment
New:
Additional:

4 Feedback on strength
and weakness

5 Areas of improvements:

Recommended by Appraiser Recommended by Reviewer

Approved by: CEO/HR Manager

Date:

Acknowledgement by Appraisee: