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Fillable Printable Exempt employee evaluation form

Fillable Printable Exempt employee evaluation form

Exempt employee evaluation form

Exempt employee evaluation form

Exempt Employee Performance Evaluation - Part I - Page 1
Exempt Employee Evaluation Form
Cover Page/Signatures
Employee Name: ___________________________________________
Employee Number: ____________________
Evaluator Name: ___________________________________________
Evaluation Period:
From: ______________________ To: ______________________
Type of Evaluation:
____ Annual
____ Probationary
____ Other
Employee Comments:
Signatures:
___________________________________________________
Employee Date
Signature does not indicate agreement but indicates that the evaluation has been reviewed with
the employee.
___________________________________________________
Evaluator Date
___________________________________________________
Department Director Date
INDEPENDENCE
SAMPLEN ONLY - May not be current evaluation
Exempt Employee Performance Evaluation - Part I - Page 2
Exempt Employee Performance Evaluation
Part I - Review of Past Evaluation Period - Narrative
Instructions: The supervisor should complete this section after reviewing the employee's self
evaluation form. You may use this form, make your comments directly on the employee's
self evaluation, or use a separate sheet. Discuss your written comments with the employee
before submitting the completed evaluation.
A. Review of Job Description
Review the employee's job description with him/her. Be sure you share the same set of
performance expectations. If any changes are needed to the job description, submit them
to Personnel.
B. Goals from Last Evaluation
Review the goals identified on the employee's last evaluation. List them here, note
whether they were accomplished, and evaluate the way in which they were accomplished.
C. Exceptions to Goals
Significant Accomplishments during the Period. Goals and priorities often change during
the evaluation period. Note any significant professional accomplishments of the
employee that were not listed in the previous year's goals. What behavior changes, new
skills, and achievements can you identify?
Challenges during the Period. Note the challenges the employee faced during the review
period. Were there goals that were not accomplished? How did the employee deal with
challenges? How could the employee have faced challenges and problems more
productively?
Exempt Employee Evaluation Form - Part II - Page 3
Exempt Employee Evaluation Form
Part II - Work Related Behaviors
Instructions: The supervisor will complete this form after reviewing the employee's self evaluation. If a
behavioral descriptor does not apply to the employee's job (i.e., the employee is not a supervisor and the
descriptor rates supervision), check "N/A." It is REQUIRED that you provide specific examples and comments
if an employee is rated as "Below Expectations" or "Exceeds Expectations." The more specific you are, the more
your employee will learn from this evaluation. List and rate any Evaluator-Defined descriptors at the end of this
form. Make sure your Evaluator-Defined descriptors are work-related and objective; call Personnel if you need
help developing descriptors. Discuss your written comments with the employee before submitting the completed
evaluation.
N/A
Below Meets
Exceeds
Expectations
Comments/Specific Examples
REQUIRED if employee is rated
"Below Expectations" or "Exceeds
Expectations"
Communication Skills
written materials are accurate, well
constructed, and easy to understand
sensitive to audience needs when
speaking or writing; uses sensitivity
and diplomacy when speaking
demonstrates appropriate listening
behaviors
communications accurately
represent City policy
provides direct and honest
responses to questions
anticipates and addresses possible
questions/concerns
demonstrates courteous and
businesslike telephone manners
shares work-related information
appropriately
seeks first to understand, then to be
understood
Exempt Employee Evaluation Form - Part II - Page 4
N/A
Below Meets
Exceeds
Expectations
Comments/Specific Examples
REQUIRED if employee is rated
"Below Expectations" or "Exceeds
Expectations"
Professionalism
accepts assignments, even tough or
unglamourous ones, willingly
maintains confidentiality when
necessary
does what needs to be done without
being told
maintains productivity, even under
pressure
takes responsibility for actions
can be counted on to follow through
on promises and assignments
attends required meetings
is prompt to appointments/meetings
models behavior expected of others
observes regular work hours; has
good attendance
Decision Making/Problem
Solving
seeks relevant expert advice before
acting
produces expected results; re-thinks
if necessary
recognizes problem areas; clearly
defines problems
takes responsibility for outcome of
decisions
encourages participation by those
who will be impacted by a decision;
Exempt Employee Evaluation Form - Part II - Page 5
N/A
Below Meets
Exceeds
Expectations
Comments/Specific Examples
REQUIRED if employee is rated
"Below Expectations" or "Exceeds
Expectations"
seeks partnerships with other
departments/agencies
demonstrates openness to creative/
innovative solutions
strives for win/win solutions to
problems
follows through to be sure decisions
are implemented
makes decisions which are
supported by facts and consistent
with policy
Job Knowledge and Application
is a resource person that others seek
out
sees how job related to
department/City goals
can readily and easily answer job-
related questions
attends training to keep knowledge
current
attends meetings when new
procedures are presented
recommends areas when
productivity can be improved
learns from mistakes; does not
repeat the same mistakes
Setting and Meeting Goals and
Objectives
effectively blends personal goals
with organizational objectives
Exempt Employee Evaluation Form - Part II - Page 6
N/A
Below Meets
Exceeds
Expectations
Comments/Specific Examples
REQUIRED if employee is rated
"Below Expectations" or "Exceeds
Expectations"
provides timely and meaningful
progress reports on attainment of
objectives
consistently meets deadlines for
agendas, status reports, budget, and
other routine assignments
establishes priorities necessary to
attain objectives, putting first things
first
establishes ambitious, but realistic
goals, beginning with the end in
mind
plans ahead and communicates
plans to those affected
accurately anticipates and projects
costs
achieves work program results
while controlling expenditures
within budget
Customer and Employee
Relations
treats customers, peers, and
subordinates with respect
treats others' feelings and needs
with sensitivity
responds to messages promptly
trains staff to react positively to
citizen concerns
solicits and gives attention to
concerns of all community groups
and individuals
Exempt Employee Evaluation Form - Part II - Page 7
N/A
Below Meets
Exceeds
Expectations
Comments/Specific Examples
REQUIRED if employee is rated
"Below Expectations" or "Exceeds
Expectations"
promotes City activities and
services
is tolerant of others working styles
actively contributes to team
efforts/goals
receptive and approachable in
formal and informal settings
Ability to Supervise Others
Omit this section for employees who do not supervise.
provides staff with fair and timely
performance evaluations; provides
regular feedback to staff;
recognizes staff accomplishments
directs staff and resources to meet
deadlines
assists in meeting the City’s
affirmative action goals
stays informed on subordinates’ job
assignments
uses delegation as a means of
employee development; controls
and monitors delegated work
supports educational/development
opportunities for staff
knows and correctly applies rules
contained in collective bargaining
agreement(s) and Employee
Handbook
addresses performance issues
promptly and fairly
is accessible to staff; encourages
feedback, is a positive
Exempt Employee Evaluation Form - Part II - Page 8
N/A
Below Meets
Exceeds
Expectations
Comments/Specific Examples
REQUIRED if employee is rated
"Below Expectations" or "Exceeds
Expectations"
communicator
Safety and Risk Management
makes safety a priority (budget,
training time for staff)
promptly reports and investigates
accidents, injuries, claims
achieves work goals without
sacrificing employee or citizen
safety
brings injured workers back to
regular or light duty work as soon
as possible; utilizes return-to-work
employees from other departments
when possible
follows up on and corrects reported
hazards
holds staff accountable to safety
procedures; sets a good example
Evaluator-Defined Descriptors
Exempt Employee Performance Evaluation
Exempt Employee Performance Evaluation - Part III - Page 9
Part III - Looking to the Future - Narrative
Instructions: The supervisor should complete this section after reviewing the employee's self evaluation
form. Discuss goals and career development plans with the employee before submitting the completed
evaluation.
Goals for the Upcoming Review Period
What should be the employee's work emphasis for the next year? Where should s/he be in one year in terms
of responsibility and job accomplishments? Does the employee have work behaviors that need to be
changed? Does the employee need special training or work assignments to meet his/her career goals? How
can you help the employee to be more effective?
Goals - List them here. Goals should be specific.
Objective Resources Needed Target Date
Training/Development Expectations - List them here.
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