FORMULIR PENILAIAN KERJA KARYAWAN BARU

Evaluation Sheet for New Hire

NAMA& NIK JABATAN
SUHERPAN SGS TT
Name & NIK Position
DIVISI COST CENTER
Division
TANGGAL MASUK TANGGAL PENILAIAN
11-Jul-17 25-Jun-19
Entry Date Evaluation Date
LOKASI/KOTA/REGIONAL
CLUSTER 16/BEKASI/JABODETABEK EAST
Location/City/Region
JENIS KARYAWAN KARYAWAN TETAP DENGAN PERCOBAAN KARYAWAN KONTRAK
Employment
¨ Permanent employee with probation
þ Contract employee

I. PERFORMANCE
WEIGHT SCORE FINAL SCORE
NO PERFORMANCE OBJECTIVES TARGET ACTUAL
(%) (1-4) (Weight x Score)

1 SGS Produktivity 8 9 50% 4 2.00

2 #Produktive SGS 15,277 17,245 50% 4 2.00

100%
LEGEND
Performance Score 4.00
SCORE DESCRIPTION
4 Actual performance > 110%
3 90% < Actual Performance ≤110%
2 70% < Actual Performance ≤90%
1 Actual Performance ≤ 70%
II. COMPETENCIES
NO COMPETENCIES WEIGHT SCORE FINAL SCORE SCORE 1 SCORE 2
(%) (1-4) (Weight x Score) (Weak) (Moderate)

Unable to complete Able to complete most

1. Work Efficiency 15% 4 0.60 assigned work. assigned work

Work quality is below Work quality meets

2. Work Quality 15% 4 0.60 expectations expectations

Weak delivery and Moderate delivery and

3. Communication 10% 4 0.40 content content

Leadership (min score

should be 2 for
Supervisors and above)
Able to manage people
4. 10% 3 0.30 Unable to lead
to achieve work goals.

Problem solving (min

score should be 3 for
Professional Staff and
above) Unable to identify the Able to identify the real
5. 10% 3 0.30 real problems and the problems or the causes
causes of the problems. of the problems

Team Work (min score

should be 3 for all Staff)
Does not consider the
Considers the effect of
6. 10% 3 0.30 effect of personal work
personal work on others
on others.

Lacks capacity to learn. Shows capacity to learn.

7. Potential 10% 3 0.30 Lacks capacity to take Shows capacity to take
new responsibilities. new responsibilities.

Waits for instructions to

do the job. Prefers to Does the job as
8. Initiative 10% 3 0.30 stay in the comfort instructed. Initiates
zone/status quo rather change occasionally.
than initiate the change.

Shows some ability to

Lacks ability to plan. plan. Shows some ability
Planning and
9. 10% 3 0.30 Lacks ability to set to set priorities. Shows
Organizing priorities. some ability to organize
work tasks.

Total Competencies Score 3.40

III. FINAL SCORE

 Final Score = (Performance × 70%) + (Competencies × 30%)

Performance 4.00 × 70% = 2.8

Competencies 3.40 × 30% = 1.02 +

Total Score
3.82
IV. REMARK ON PERFORMANCE REVIEW
Harus bisa lebih lagi meningatkan Perfomance per masing2 OM SGS (Khusus nya OMH)

Recommendation : Pass / Fail

Decision : Terminated / Permanent Employement / Contract Employement _12_ months
Salary :
Effective date :

DIBUAT OLEH (Line Manager) DISETUJUI OLE

Prepared by (Line Manager) Approved by (Division Head)

Nama HENDRY NURWEDYA Nama

Name Name
Tanggal Tanggal
Date Date

DITERIMA OLEH (HR Branch Office) DIKETAHUI OLEH (HR Head Office)
Received by (HR Branch Office) Acknowledged by (HR Head Office)

Nama Nama
Name Name
Tanggal Tanggal
Date Date
 SCORE 2 SCORE 3 SCORE 4
(Moderate) (Strong) (Exceptional)

Able to complete most Able to complete all Consistently delivers additional

assigned work assigned work work.

Work quality meets and

Work quality meets Work quality consistently exceeds
sometimes exceeds
expectations expectations
expectations

Moderate delivery and Good delivery and Excellent delivery and very
content adequate content adequate content

Able to manage people

Able to manage people to achieve work goals. Able to lead a team to achieve
to achieve work goals. Sets clear directions for excellent team results. Visionary
others.

Able to identify the real problems

Able to identify the real
or the causes of the problems.
Able to identify the real problems or the causes
Able to solve problems
problems or the causes of the problems. Able to
systematically and analytically
of the problems solve problems with
with significant results and has a
good results.
back-up plan.

Considers the effect of Considers the effect of personal

personal work on others. work on others. Willing to stretch
Considers the effect of
Willing to stretch him/herself to achieve team
personal work on others
him/herself to achieve goals.Able to mediate differences
team goals. in team.

Shows very strong capacity to

Shows strong capacity to
Shows capacity to learn. learn. Shows very strong capacity
learn. Shows strong
Shows capacity to take to take new and challenging
capacity to take new
new responsibilities. responsibilities.Excel in
responsibilities.
constrained situations.

Does the job more than

Does the job as instructed. Frequently Actively initiate ideas that add
instructed. Initiates initiates changes that value to the current situation and
change occasionally. create a positive impact with innovation.
in the current situation.

Shows some ability to

plan. Shows some ability Able to plan. Able to set Shows high skiils in planning and
to set priorities. Shows priorities. Able to priority setting. Very organized in
some ability to organize organize work tasks. accomplishing work tasks.
work tasks.
 (minimum total score should be 2.75)

DISETUJUI OLEH
Approved by (Group Head)

Nama
Name
Tanggal
Date