hr-survey.com

Safety - Performance Management Assessment Sample #10


Performance Assessments that include Safety:
Assessment 1 (5-point scale; IDP Comments)
Assessment 2 (3-point scale with Comments)
Assessment 3 (Manager Assessment; 360-Feedback)
Assessment 4 (3-point scale; Rating Limits)
Assessment 5 (3-point scale; Rating Limits)
Assessment 6 (5-point scale with Comments)
Assessment 7 (Comment Boxes Only; IDP)
Assessment 8 (Comment Boxes Only)
Assessment 9 (3-point scale with Letter Grade)
Assessment 10 (360-Feedback; Bonus/Merit Pay)
Assessment 11 (Core Values & Job Competencies)
Assessment 12 (4-point scale; 6 Comment Boxes)

Performance Management System
Supervisor: [Supervisor Name]


Signature: ___________________


Date: _____________ 		Employee: [Employee Name]


Signature: ___________________


Date: ___________
Job Title: Mid-Level Manager in X Department Hire Date:
Instructions:
This performance appraisal program is designed to provide a standardized method to:
  1. Provide an objective evaluation of an employee's performance and to share this feedback with the employee
  2. Assist in determining the true development needs of the employee and actions that should be taken to improve their job performance.
  3. This form is intended to ensure fair and equitable salary management. Please note that this review is one of several factors considered in salary decisions.

Employee Input

Please provide brief answers to the questions below. Your feedback is vital to us. We aim to capture all your achievements during the performance review period. The details you enter will be part of your Performance Appraisal. If you need to include any additional printed sheets, please sign, date, and submit them to your Department Head. Additionally, if someone else should contribute to this review, kindly provide their name and contact details.

Part 1: Status Recommendation

If currently on Probational Status:



If on Regular Employment Status:

Justification for the above Status Recommendation:


Competencies Included:
Safety, Initiative, Customer Focus, Strategic Insight, Accountability

Part 2: Results of 360-Degree Feedback

Edit this Survey
Would you like to edit this survey? Click here to begin.


  1. Safety: Performs work safely. Participates in safety training as applicable. Identifies and addresses safety needs. Works to implement corrective safety measures.
  1. Initiative: Acts independently to solve pressing needs. Initiates the development of new products. Acts quickly to address any issues or problems. Addresses small problems before they become big ones.
  1. Customer Focus: Is consistent in services provided to customers. Delivers on commitments made to customers. Is pro-active in dealing with customers and addressing their needs. Creates documents that meet the customer's specifications.
  1. Strategic Insight: Works with others to develop insights into the resources and actions required to produce desired results. Strategically aligns projects to the goals of the company. Understands how to strategically grow the business and increase customers. Identifies potential problems before they become critical incidents.
  1. Accountability: Takes charge of addressing and solving problems. Holds self and others accountable for meeting the deadline. Commits to leading the initiatives to solving critical issues. Makes sure the supervisor is always informed of any important events.

Part 3: Summary of 360-Degree Feedback

Part 4: Bonus Pay

The supervisor now must consider which of the following adjustments to make to compensation.
Changes made here are reflected in the Salary Recommendations section at the beginning of this form.
Midpoint of Scale Status

Consider eligibility for Movement to Midpoint:
Yes: If Yes, continue with this section below
No, If no continue to next section

Depending on your responses, the computer may show (or hide) certain elements of the form.
Merit Pay Section
When this form was initially loaded, the employee was eligible for Merit Pay.
However, if the scores on Job Performance Criteria were too low, then the eligibility would change.

Consider eligibility for Merit Pay:
Yes: If Yes, continue with this section below
No, If no continue to next section
Change the scores on Job Performance Criteria to see how it affects this section.
Experience Pay Section

Eligible for Experience Pay:
Yes: If Yes, continue with this section below
No, If no continue to next section



Part 5: Individual Productivity and/or SMART Goals

Employee Comments


Supervisor Comments


Part 6: Team Productivity and/or SMART Goals

Employee Comments


Supervisor Comments