Name:
Role:
Date of Performance Appraisal:
Name of Manager:
Before the Performance Appraisal
During the Performance Appraisal
After the Performance Appraisal
•Employee and manager to complete
sections 1 to 5 and 7 individually before
the Performance Appraisal meeting
•Read through guidance documents
referred to below as required.
•At Performance Appraisal meeting – employee
and manager discuss & review sections 1 to 5
together
•Manager completes section 6 & issues Overall
Performance Score
•Manager and employee discuss and review
sections 7, 8 and 9 together.
•Manager to log Performance Appraisal
date and score on ESR.
•One Master copy - completed, signed,
dated, placed on employees file & copy
given to employee
•Next appraisal and 1 to 1 meetings booked
1 to 1
(Section 10)
6 Month Review
(Section 10)
1 to 1
(Section 10)
Documents to download and read in preparation
Trust-Values / Handy Guide to Values
Talent Management / Leadership Academy Maximising Potential Guide
Performance Appraisal /Employee Guide to Appraisal / Managers Guide to Setting Smart Objectives
1
Performance Appraisal Template – All Staff V8.4
In preparing for your appraisal you will need to consider how you have performed this year, whether you have met your objectives, how people find working
with you and whether you have demonstrated the Trust values and behaviours in everything you do?
Successes and Achievements: What has worked well this year? What has been learnt? What have been the most satisfying elements of your role?
Employee comments
Manager comments
Challenges and development needs: What has not worked so well this year? What were the low points? What have been the least satisfying elements of
your role?
Employee comments
Manager comments
Consider getting feedback from others on what you do and how you do it (360 Feedback Request Form for staff between Bands 1 to 9, HLM for Bands 8b+)
2
Performance Appraisal Template – All Staff V8.4
Here you need to review progress against objectives agreed at last year’s performance appraisal, determining whether the achievement of the objective has
Exceeded Expectations, Meeting Expectations or Needs Improvement.
SMART OBJECTIVES – Specific, Measurable, Achievable, Relevant and Time-bound
What was expected of you?
Specific, Achievable, Relevant
Measure of Success
Measurable
Measurement of performance against objective
Rating
When was
this to be
achieved?

Contribution and Success
How did you do?
Time-bound


Exceeds
Expectations
Meeting
Expectations
Needs
Improvement
Employee
Manager
Employee
Manager
Employee
Manager
3
Performance Appraisal Template – All Staff V8.4
SMART OBJECTIVES – Specific, Measurable, Achievable, Relevant and Time-bound
What was expected of you?
Specific, Achievable, Relevant
Measure of Success
Measurable
Measurement of performance against objective
Rating
When was
this to be
achieved?

Contribution and Success
How did you do?
Time-bound


Needs
Improvement
Meeting
Expectations
Exceeds
Expectations
Employee
Manager
Employee
Manager
Rating
Overall Objective rating (based on most frequent)
Objectives – Has the employee completed their objectives? (Select appropriate rating, based on most frequent
rating across all objectives):
4
None/some
objectives
completed
Most/all
objectives
completed
All objectives
completed
and some
exceeded
Needs
Improvement
Meeting
Expectations
Exceeding
Expectations



Needs
Improvement
Meeting
Expectations
Exceeds
Expectations
Performance Appraisal Template – All Staff V8.4
Please refer to the Values Standards and Behaviours compact for further guidance (appendix A).
Employee and line managers to consider what was done well and what
could be done better, providing evidence and examples for discussion.
Evidence of Achievement
Tick the rating most appropriate to the employees demonstration of the
Trust Values and Behaviours
Don’t want
to see
Expect to
see
Love to see
Agreed
Rating
Employee
Compassionate and
kind
Friendly and
courteous
Manager
Attentive and helpful
Protect dignity
Employee and line managers to consider what was done well and what
could be done better, providing evidence and examples for discussion.
Evidence of Achievement
Tick the rating most appropriate to the employees demonstration of the
Trust Values and Behaviours
Don’t want
to see
Expect to
see
Love to see
Agreed
Rating
Employee
Keep people safe
Deliver the best
outcomes
Reassuringly
professional
Manager
Personal
Responsibility
5
Performance Appraisal Template – All Staff V8.4
Employee and line managers to consider what was done well and what
could be done better, providing evidence and examples for discussion.
Evidence of Achievement
Tick the rating most appropriate to the employees demonstration of the
Trust Values and Behaviours
Don’t want
to see
Expect to
see
Agreed
Rating
Love to see
Employee
Listen and hear
Explain and involve
Work in partnership
Manager
Respect everyone’s
time
Employee and line managers to consider what was done well and what
could be done better, providing evidence and examples for discussion.
Evidence of Achievement
Tick the rating most appropriate to the employees demonstration of the
Trust Values and Behaviours
Don’t want
to see
Expect to
see
Agreed
Rating
Love to see
Employee
Efficient and simplified
Courage to give and
receive feedback
Develop through
learning
Manager
Engage, innovate and
research
Rating

Overall behaviour rating (based on most frequent rating achieved)
Don’t want to
see
Expect to see
Love to see


Values and Behaviours – What overall rating has the employee achieved in their values and behaviours
evaluation? (select the appropriate rating based on most frequent across all behaviours)
6
Needs
Improvement
Meeting
Expectations
Needs
Improvement
Meeting
Expectations
Exceeds
Expectations
Exceeding
Expectations
Performance Appraisal Template – All Staff V8.4
This section should be completed in relation to your own development and training, and that of any staff you have line management responsibility for.
You
Your Team (if you are a manager)
Statutory and Mandatory
Is it up to date? Any Comments
Training required to
undertaken
(Essential Skills Booklet and
Face to Face training)
Refer to Individual Essential Skills
Matrix (ESR)
Other Training and
Development undertaken this
year:
7
Performance Appraisal Template – All Staff V8.4
If not relevant to your role, please go to section 6.
Clinical and Professional
Requirements needed for your
role (i.e. proof of up to date PIN,
registration with GMC, NMC or
HCPC as appropriate and CPD):
Annual NMC Revalidation
Review
Date of Revalidation
Ensure NMC Code of Conduct is
available at meeting
Criteria
Manager to check that
employee is working towards
NMC Revalidation.
Use Objectives/PDP section to
ensure appropriate preparation
for revalidation.
Ensure professional portfolio is
up to date
Yes/No
Comments/Actions
Progressing to meet NMC
Revalidation requirements.
450 Practice Hours
CPD – 35 hrs (20 participatory)
Practice Related Feedback x5
Reflections x5
(Min. over 3 year period)
Continues to remain
competent for practice by
meeting the requirements of
the NMC Code
At year 3 complete the Confirmation of NMC Revalidation form with your Confirmer
(this may be completed up to 1 year prior to revalidation date)
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Performance Appraisal Template – All Staff V8.4
Circle/Highlight Agreed Rating and refer to matrix for
Overall Performance Score
Performance Scoring Matrix
Objectives – Has the employee completed their objectives? (Select appropriate rating, based on most
frequent rating across all objectives in Section 2):
Behaviours – What overall rating has the employee achieved in their values and behaviours evaluation?
(select the appropriate rating based on most frequent across all behaviours in section 3)
Essential Skills – Has the employee completed their required Statutory and Mandatory Training (Essential
Skills)? (Select appropriate response):
Needs
Improvement
Meeting
Expectations
Exceeding
Expectations
Needs
Improvement
Meeting
Expectations
Exceeding
Expectations
Has not completed
Essential Skills
Has completed all Essential Skills
5 – Exceptional – Continually meeting and exceeding all objectives and behaviours
4 – Very Good – Meets objectives & required standard of behaviours/often exceeding in some
3 – Good – Meets most objectives and behaviours
2 – Needs Improvement/Development – Achieving few key objectives and behaviours or
Achieving all or most objectives and behaviours but has not completed Essential Skills.
Performance Management to occur guidance / policy
1 – Poor – Failed to achieve any key objectives, behaviours and requirements of the role or
Achieving few key objectives and behaviours but has not completed Essential Skills.
Performance Management to occur guidance / policy
NB. If employee has not completed all essential skills, default score is
2 or 1 unless there is substantial mitigation. Where Essential skills are
non-compliant an action plan for completion within 4 weeks is required.
9
Employee Overall Performance Score =
Performance Appraisal Template – All Staff V8.4
The focus of this section should be on your potential and aspirations for future career development, and for your manager to consider succession
planning where you may be suitable for development into critical posts in the future.
Employee Reflections
Thinking about your current role, your life and your career are you…
I’m unsure of this role… I’m
new to the role or this may
not be the right role for me ☐
or
I’m content with this role... I
just want to do this role well
☐
or
I’m content with this role... I
want to develop further
within this role
☐
or
Ready for more… I want to be
challenged further or take the
next step in my career
Why have you chosen the option you
have?
What do you like about the current job
you do? What don’t you like and why?
What support do you need from your
manager, the team or the organisation to
fulfil your potential for the future?
If you want to develop or are ready for
more, how ready are you for a change?
10
☐ Now
☐1 Year
☐2 to 3 years
Performance Appraisal Template – All Staff V8.4
☐
Manager Reflections
Development interventions required?
Manager to consider where individuals may be suitable for critical posts as
indicated in succession plans.
If the individual does not wish to progress beyond current grade – How can they
share and pass on their knowledge to others?
The graphic above is an extract from the Leadership Academy
Maximising Potential Guide. This can be used to support the
discussion of career potential and associated development. For
further information you can visit the Talent Management webpage.
11
Performance Appraisal Template – All Staff V8.4
12
SMART OBJECTIVES – Specific, Measurable, Achievable, Relevant and Time-bound
Team objectives (linked to
Trust Objectives)
What is expected of you?
Measure of Success
Specific, Achievable, Relevant
Measurable
When is this to be
achieved by?
Time-bound

Deliver safe, high quality patient care
Continually improve the patient experience
Ensure delivery of the national constitutional standards
Create a healthy organisational culture where staff report they are well led and have
high levels of satisfaction working in the Trust.
Achieve financial health and sustainability




Trust Objectives
Manager should consider how the individual being appraised can support the Trust Strategic Goals and Team objectives when setting individual
SMART objectives. Managers Guide to SMART Objectives
Performance Appraisal Template – All Staff V8.4
13
Please confirm which level of the Passport to Manage
Competency Framework you are working to (Level 1 to 5)
SMART MANAGEMENT & LEADERSHIP OBJECTIVES – Specific, Measurable, Achievable, Relevant and Time-bound
Team objectives (linked to
Trust Objectives)
What is expected of you?
Measure of Success
Specific, Achievable, Relevant
Measurable
When is this to be
achieved by?
T
ime-bound
mmm/yy
Ensure you are appropriately skilled and compliant
with all aspects of Passport to Manage Management
Competency Framework at the respective level for
your role.
Competency framework achieved and
demonstrated in role (add as appendix to
document).
Demonstrate effective leadership behaviours in
accordance with the elements of the NHS Healthcare
Leadership Model (HLM)
HLM self assessment and/or 360 Feedback
process completed or internal feedback
completed, with agreed development plan in
place to address any areas of improvement
identified
mmm/yy
Ensure all staff within your team engage in a robust
Performance Appraisal annually, and have
completed all Statutory and Mandatory Training
(Essential Skills) required for their specific role within
the mandated timeframe.
Exceed Target of 85% for team Performance
Appraisals and Essential Skills Training.
Staff are clear on expectations and are
supported to perform the duties of their role,
including receiving the appropriate personal
development
All staff appraised
every 12 months.
Full team compliance
by mmm/yy

Deliver safe, high quality patient care
Continually improve the patient experience
Ensure delivery of the national constitutional standards
Create a healthy organisational culture where staff report they are well led and have high levels
of satisfaction working in the Trust.
Achieve financial health and sustainability




Trust Objectives
Management and Leadership Objectives to be included for those staff
who have a management role, line management responsibility
Performance Appraisal Template – All Staff V8.4
The PDP underpins and supports delivery of objectives, career aspirations and values and behaviours. How will this be achieved?
Personal Development Plan:
Please refer to information about the training and support available from the Trust (See Management and Leadership Development Programme, The Trust
Learning Zone etc.). Please also consider shadowing, projects, research, coaching/mentoring as well as formal training opportunities.
Employee Signature:
Date:
Manager Signature:
Date:
Senior Manager Signature if Employee scored 2 or 1 in Overall Performance Score
Remember to record on ESR (Use ‘192 Bands 1 to 9 Rating’ Template on ESR) and set the dates for 1:1’s and the next Performance Appraisal!
14
Performance Appraisal Template – All Staff V8.4
Quarterly 1-1: 3 months after objectives are set
How are things going since last review?
What progress has been made against Objectives?
Essential Skills/Training/Competencies Completion and Compliance:
Examples of when employee has or hasn’t demonstration of values and behaviours
What development and learning has taken place so far (link to Talent and PDP)
Items for Employee to Follow Up:
Items for Manager to Follow Up:
Employees Name & Signature:
Managers Name & Signature:
Date:
Mid-Year Review: 6 months after objectives are set
How are things going since last review?
What progress has been made against Objectives?
Essential Skills/Training/Competencies Completion and Compliance:
Examples of when employee has or hasn’t demonstration of values and behaviours
What development and learning has taken place so far (link to Talent and PDP)
Items for Employee to Follow Up:
Items for Manager to Follow Up:
Employees Name & Signature:
Managers Name & Signature:
Date:
Quarterly 1-1: 9 months after objectives are set
How are things going since last review?
What progress has been made against Objectives?
Essential Skills/Training/Competencies Completion and Compliance:
Examples of when employee has or hasn’t demonstration of values and behaviours
What development and learning has taken place so far (link to Talent and PDP)
Items for Employee to Follow Up:
Items for Manager to Follow Up:
Employees Name & Signature:
Managers Name & Signature:
Date:
Appendix A