Staff Self-Review Worksheet
Name:____________________________________
Date: ____________________________________
Title: ____________________________________
Department: ______________________________
As an employee, you are encouraged to complete this worksheet. It is designed to help you and your
supervisor prepare for your performance evaluation discussion. Give a completed copy of this worksheet to
your supervisor at least two days prior to the evaluation discussion and keep a copy for yourself.
1. Are there any questions about job performance expectations or areas that are unclear? Please
explain below:
2. List special contributions you feel you have made to your department for the current evaluation
period. (These may include activities, awards, and/or recognitions since your last full review.)
3. List any notable obstacles you encountered in accomplishing your job responsibilities during the
last evaluation period, particularly obstacles encountered in attempting to reach the goals you and
your supervisor had set. Please include your plan to overcome these obstacles:
4. What performance standards do you want/need to improve in the next year? How do you intend
to achieve these goals?
5. Add any additional information that you wish to have considered in your evaluation:
Signature: ______________________________ Date: ____________________
WU WAY WORKSHOPS | PERFORMANCE REVIEW SELF REVIEW |
Print Form
Employee
Performance
Review 1/17
SELF-REVIEW
Human Resources, 118 Morgan Hall, 670-1538
Employee’s Name
WIN #
Department
Position Title
Recommendation:
Retain
REVIEW PERIOD From:
Overall Rating _______ (from pg 2)
Probationary
Extend probation
months
more
To:
Type of Performance Review:
Annual
Special
Unsatisfactory; recommended
action:
Other
An overall rating less than 3.0 will be addressed in a Perfomance Improvement Plan (PIP)
The area below may be used to describe employee’s strengths, needs for improvement where appropriate, developmental plans, and/or
additional comments as necessary.
SPECIAL EXPECTATIONS FOR UPCOMING REVIEW PERIOD:
OVERALL COMMENTS:
Supervisor’s Signature________________________________________ Date________________
REVIEWER’S COMMENTS
Reviewer’s Signature______________________
___________________
Date________________
EMPLOYEE COMMENTS (optional)
Employee’s Signature__________________________________________ Date_______________
My signature indicates ONLY that I have reviewed the document and discussed the contents with my supervisor.
PERFORMANCE EXPECTATIONS AND NUMERICAL RATING CODES
INSTRUCTIONS: The supervisor should assign a numerical rating to each of the applicable categories below. Ratings should be given
in whole numbers only (no percentages). TOTALS should be computed at the bottom of each rating column. To determine the
OVERALL RATING, add totals together and divide by the number of performance expectations rated. Additional pages may be used if
necessary.
***SELF REVIEW***
1=Does not meet expectations 2=Needs improvement meeting expectations 3=Consistently meets
expectations 4=Occasionally exceeds expectations 5=Consistently exceeds expectations
PERFORMANCE EXPECTATIONS
1
2
3
4
5
COMMENTS ON PERFORMANCE
1. QUALITY OF WORK: Work is accurate, thorough,
neat and effective.
2. PRODUCTIVITY: Work produced compares favorably
to job expectations.
3. JOB KNOWLEDGE: Employee understands duties
and responsibilities of the job.
4. JUDGMENT: Required decision-making is logical and
sound in relation to effective performance of the job.
5. INITIATIVE: Employee exhibits appropriate degree of
initiative and effort in performance of duties.
6. DEPENDABILITY: Work assignments are
carried out effectively and timely.
7. TEAMWORK: Employee works with others
effectively; willing to vary work schedules/assignments
as needed.
8. LEADERSHIP (if applicable): Through effective formal
or informal direction of others, employee ensures work
is completed satisfactorily.
9. COMPLIANCE: Employee complies with the
University’s policies and work rules (i.e.: attendance,
punctuality, etc.) during the review period.
10. ADDITIONAL EXPECTATION (describe):
11. ADDITIONAL EXPECTATION (describe):
TOTAL EACH COLUMN:
Grand total, all columns_____ /Total number of Performance Expectations rated_____=_______
OVERALL NUMERICAL RATING (grand total divided by total number performance expectations)
A Perfomance Improvement Plan (PIP) will be initiated to address an overall rating of less than 3.0.
Please contact Human Resources for assistance.