Self Evaluation

Please enter a number in the fields labeled "Score 1-4". Based on this scale:

1= needs work
2= average
3= above average
4= exceptional

Your Name

Your Email

Your job title

Supervisor name

Department

Date of hire

Ethical treatment of staff and participants

Adherence to policy

Dependability

Initiative

Judgement

Interpersonal Skills

Responsibilities

Training subordinates

Please list all formal training this past fiscal year.

Total training time this fiscal year:

Ability to communicate, solve problems and find solutions.

Financial goals met for department.

Adherence to your budgetary goals
If not, please explain

Punctuality
How many days were you late to work this year?
How many times did you have to leave early?

Departments met Key Performance Indicators?
Please identify any KPI's that were not met and the plan to meet them in the future.

List upcoming needed capital improvements or larger than usual purchases for your department.

Explain your succession plan as of today. Who would take over your responsibilities if something happened to you.

Did you take vacation this year? YesNo

List achievements and accomplishments from last years review.

List areas you need to develop and improve.

Requests or concerns, career fulfillment, what can your supervisor do to help you improve.

Suggestions for next year.