Fillable Printable Performance Evaluation Form - Connecticut
Fillable Printable Performance Evaluation Form - Connecticut
Performance Evaluation Form - Connecticut
State of Connecticut Human Resources
Performance Appraisal
Form #: PER-125
Revision Date: 8/4//2005
________________________________________________________________________
TYPE OF PERFORMANCE APPRAISAL
INITIAL PROBATIONARY ANNUAL PROMOTIONAL OTHER (Specify)
EMPLOYEE NAME CLASS TITLE DATE
DIVISION DEPARTMENT DATE OF LAST REVIEW
INSTRUCTIONS:
Evaluate the employee on the job now being performed. Mark the box above the
horizontal line that most nearly coincides with your overall judgment on each quality. The
care and accuracy with which this appraisal is made will determine its value to you, to the
employee and to the agency.
Consider the employee’s performance since the last appraisal
and show by a check (x) whether he/she has regressed,
remained the same, or shown improvement in each of the
qualities listed to the left.
JOB ELEMENTS
GOOD
LESS THAN GOOD
HAS
IMPROVED
LITTLE
OR NO
CHANGE
HAS
REGRESSED
KNOWLEDGE OF WORK:
Consider knowledge of job
gained through experience,
general education specialized
training
Well
informed on
all phases of
work.
Knowledge
thorough enough
to perform without
assistance.
Adequate grasp
of essentials.
Some
assistance.
Requires
considerable
assistance.
Inadequate
knowledge.
COMMENTS
QUANTITY OF WORK:
Consider the volume of work
produced under normal
conditions. Disregard errors.
Rapid worker.
Unusually
large
production.
Turns out large
volume.
Average. Volume
below
average.
Very slow
worker.
COMMENTS
QUALITY OF WORK:
Consider neatness, accuracy
and dependability of results
regardless of volume.
Exceptionally
accurate,
practically no
mistakes.
Seldom necessary
to check work.
Acceptable,
usually neat,
occasional
errors or
rejections.
Often
unacceptable,
frequent
errors or
rejections.
Too many
errors or
rejections.
COMMENTS
ABILITY TO LEARN
NEW DUTIES:
Consider the speed with which
employee masters new routine
and grasps explanations.
Consider also ability to retain
knowledge.
Exceptionally
quick at
learning and
adjusting to
changed
conditions.
Learns rapidly.
Retains
instructions.
Average
instruction
required.
Requires a
great deal of
instruction.
Very slow at
absorbing
new
routines.
Poor
memory.
COMMENTS
INITIATIVE:
Consider the tendency to
contribute, develop and/or
carry out new ideas or
methods.
Initiative
resulting in
frequent
saving in time
and money.
Resourceful, can
meet and handle
situations in an
efficient and
timely manner.
Shows
initiative
occasionally.
Rarely shows
any initiative.
Need
constant
prodding.
COMMENTS
COOPERATION:
Consider manner of handling
work relationships.
Goes out of
way to
cooperate.
Gets along well
with associates.
Acceptable. Shows
reluctance to
cooperate.
Very poor
cooperation.
COMMENTS
JUDGMENT:
Does employee think
intelligently and make
decisions in a logical manner.
Thinks
quickly,
logically
outstanding.
Judgment usually
logical.
Fairly reliable. Inclined to be
illogical.
Poor,
unreliable.
COMMENTS
OTHER ELEMENTS:
Consider other elements of job
performance which are not
included above, yet are job
related, i.e. attendance,
physical performance on job,
supervisory ability,
affirmative action
responsibilities. *
COMMENTS
If comments pertaining to supervisory ability are appropriate, ability to delegate authority, to get work done through subordinates, and observance of personnel and affirmative
action policies should be considered.
State of Connecticut Human Resources
Performance Appraisal
Form #: PER-125
Revision Date: 8/4//2005
________________________________________________________________________
INSTRUCTIONS: Based on the appraisal you have made on the reverse side, please answer the following questions in your own words
DO YOU SEE ANY NEED FOR IMPROVEMENT ON THE PREVIOUS FACTORS? (If “Yes”, please explain)
Yes No
IS EMPLOYEE WELL SUITED FOR THE TYPE OF WORK BEING DONE? (If “No”, indicate type of work that would appear
to be more suitable)
Yes No
WHAT CONTRIBUTION HAS EMPLOYEE MADE TO DEPARTMENT, DIVISION, OR BUREAU, BEYOND NORMAL
REQUIREMENTS OF POSITION?
WHAT WOULD BE YOUR OVERALL EVALUATION OF EMPLOYEE?
Excellent Good Satisfactory Fair Unsatisfactory
SIGNATURE TITLE DATE
RATED BY:
SIGNATURE TITLE DATE
REVIEWED BY:
SIGNATURE TITLE DATE
APPROVED BY:
SIGNATURE TITLE DATE
EMPLOYEE
NOTE TO EMPLOYEE: Your signature confirms that you have seen this report and discussed it with your supervisor. It does not indicate
your agreement with or approval of the rating.
QUESTIONS TO BE ANSWERED AFTER DISCUSSION OF APPRAISAL WITH EMPLOYEE
WHAT WAS THE ATTITUDE OF THE EMPLOYEE TOWARD DISCUSSION OF APPRAISAL?
IF IMPROVEMENT IS INDICATED, WHAT SUGGESTIONS HAVE YOU MADE?
REMARK FURTHER COMMENTS YOU MAY HAVE FOR IMPROVEMENT
SIGNATURE TITLE DATE
CERTIFIED BY:
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