Planning and Evaluation Form
Performance Cycle September 1
st
– August 31
st
Employee Name
Class Title
Department/Unit
Supervisor Name
Unit Mission Statement:
How this position supports the Unit Mission:
Standards/Goals/Objectives
“Standards/Goals/Objectives” are specific statements or requirements and agreed upon by the
supervisor and the employee. “Measurement Method” reflects the evaluation basis for the expected
results. “Results Achieved” are the accomplishments of the employee during the evaluation period.
1
Standard/Goal/Objective:
Results Achieved:
☐
Level 5
☐ Level 4
☐ Level 3
☐ Level 2
☐
Level 1
Measurement Method:
2
Standard/Goal/Objective:
Results Achieved:
☐
Level 5
☐ Level 4
☐ Level 3
☐ Level 2
☐
Level 1
Measurement Method:
3
Standard/Goal/Objective:
Results Achieved:
☐
Level 5
☐ Level 4
☐ Level 3
☐ Level 2
☐
Level 1
Measurement Method:
4
Standard/Goal/Objective:
Results Achieved:
☐
Level 5
☐ Level 4
☐ Level 3
☐ Level 2
☐
Level 1
Measurement Method:
5
Standard/Goal/Objective:
Results Achieved:
☐
Level 5
☐ Level 4
☐ Level 3
☐ Level 2
☐
Level 1
Measurement Method:
6
Standard/Goal/Objective:
Results Achieved:
☐
Level 5
☐ Level 4
☐ Level 3
☐ Level 2
☐
Level 1
Measurement Method:
7
Standard/Goal/Objective:
Results Achieved:
☐
Level 5
☐ Level 4
☐ Level 3
☐ Level 2
☐
Level 1
Measurement Method:
8
Standard/Goal/Objective:
Results Achieved:
☐
Level 5
☐ Level 4
☐ Level 3
☐ Level 2
☐
Level 1
Measurement Method:
Planning and Evaluation Form
Performance Cycle September 1
st
– August 31
st
Core Competencies
The Core Competency areas are defined and have associated expectations and specific desired work behaviors.
Additional goals or objectives that are competency specific can be added to an employee’s performance plan.
Job Knowledge: Possesses knowledge of established policies and procedures. Possesses sufficient
skills and knowledge to perform all parts of the job effectively and efficiently. Provides technical
assistance to others and is consulted by others on technical matters. Pursues professional
development. Displays innovation.
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Accountability: Accepts responsibility for actions. Meets changing conditions and situations in work
responsibilities. Accepts constructive criticism and suggestions and makes appropriate changes.
Handles conflict in a constructive manner. Seeks solutions acceptable to all. Willingness to accept
supervision. Can consistently be relied on to perform in a professional manner. Seldom needs to be
reminded. Is fully ready to work at beginning of work schedule and continues until workday is done.
Does not abuse leave practices
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Interpersonal Skills: Maintains smooth working relations, support and respect of others.
Demonstrates tact and diplomacy in negotiations or confrontations with others. Contributes to
employee morale and motivation. Is accessible to others and responsive to their questions, needs and
concerns. Supports and appreciates the diversity of co-workers, students, customers, and visitors.
Shares information, credit and opportunities. Displays an appropriate balance between personal
effort and team effort and ability to establish rapport with internal and external customers.
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Communication/Verbal and Written: Uses appropriate language and terminology. Communicates in
a manner that is understood, courteous and effective. Demonstrates effective listening skills. Seeks
and considers ideas from others on issues. Keeps supervisor, co-workers and internal units informed.
Is considerate of the communication styles of others. Prepares written communications/documents
that are complete, clear and understandable.
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Customer Service: Provides prompt and friendly service to internal and external customers. Helps
identify customer needs through courteous questioning and a sincere desire to be helpful. Follows up
with customers, as appropriate, to insure satisfaction. Considers/recommends alternatives to
customers when needed.
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
All supervisors must have the following core competency in their performance plan.
Supervision/ Performance Management: Employees supervised demonstrate productivity,
competence and high morale. Provides supervision, feedback and training for employees. Utilizes
employee’s skills and abilities. Conducts performance Planning and evaluations for employees in a
timely manner. Develops goals, objectives and deadlines and communicates them to employees.
Resolves routine personnel issues or problems.
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Additional Competencies
The following are examples of additional competencies that may be appropriate for specific situations.
They are provided here only as examples and are not meant to limit the inclusion of competencies
beyond those mandated by the State.
Motivation/Commitment: Displays drive and energy in accomplishing tasks. Handles several
responsibilities concurrently. Conveys positive and professional image of work unit to others. Puts
forth-extra effort when needed. Agrees to modify schedule or adapt Programs when necessary. Self-
starter. Displays positive attitude in work assignments and interactions with others.
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Competence/Responsibility: Maintains quality/quantity standards. Accepts responsibility for all areas
of job. Uses time effectively with minimal errors. Completes work thoroughly in a reasonable amount
of time. Meets or surpasses established goals. Works accurately, neatly, and attends to detail.
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Problem Solving/Reasoning: Recognizes and analyzes work related problems. Uses available
resources to evaluate and recommend potential solutions. Ability to use good judgment to arrive at
sound conclusions. Ability to take timely action.
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
IT Security and Controls: Possesses knowledge of and adheres to University and departmental IT
Security policies and procedures, including storage, access, handling and confidentiality; ensures
security control effectiveness (i.e., controls implemented correctly, operating as intended, meeting
security requirements for information system); determines risk to organizational operations and
assets, individuals, other organizations, and the University; applies security settings appropriately.
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Additional Competency 1:
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Additional Competency 2:
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Additional Competency 3:
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5
Comments:
Supervisor Narrative
This is a space for the supervisor to provide any additional comments or feedback.
Employee Narrative
This is a space for the employee to provide any comments, information or disagreement with the
review.
