PERFORMANCE APPRAISAL

The annual interview for assessment,

Performance and development

STAFF
Name ______________________ Job Designation ______________________
Department ______________________ Grade
______________________
Employee No. ______________________ Date of joined
Reason For Appraisal
Annual Assessment or Extend Contract
Recommendation Of Promotion
Recommendation of Salary Increase

Overall Performance Summary

1. Outstanding
2. Excellence
3. Good
4. Fair
5. Poor
Proposed by,

Appraiser Department Head

Date : Date :
To be Promoted Probation (Yes / No)
New Position : Date : …………..….to………..………
Old Salary Rp.
Increase Salary
New Salary Rp.
Effective Date
Acknowledge by, Approved by,

Human Resources Manager Chief Accountant General Manager

Date : Date : Date :
 STAFF

D. Evaluation of performance

Competence Comments (be specific)

Level

Fair
Good
Excellence

Poor
Outstanding
Performance Areas of Strengths Development
Needs

5 4 3 2 1

Job knowledge

Job & technical skill

Standards of work

Following instructions & procedures

Responsibility

Commitment to self improvement

Response to training & development

Dependability in stress situation

Initiative

Attendance & punctuality

Grooming

Concern for guest

Communication

Team work

Cross-functional collaboration

Score

Total Score

2
 STAFF

F. Overall Performance

OUTSTANDING EXCELLENCE GOOD FAIR POOR

( 96 - 105 ) ( 79 – 95 ) ( 53 – 78 ) ( 36 – 52 ) ( 25 – 35 )
Has gone for beyond Has gone beyond the Has achieved the Can still improve Offers a level of
the required level of required level of performance required his/her level of performance below the
performance and or performance and or by his/her position performance to satisfy requirements of
strongly developed developed his/her the requirements of his/her position
his/her position position his/her position

Interviewee’s Comments: Appraiser’s Comments:

Reviewer’s Comments:

EMPLOYEE: APPRAISER: REVIEWER:

________________________ __________________________ ________________________
Signature Name Name

_________________________ __________________________ ________________________

Date Job designation Job designation

__________________________ ________________________
Signature Signature

__________________________ ________________________
Date Date