New York State Community Action Association
Employee Performance Evaluation
Name:
Date Completed:
Position:
Time in this position:
Supervisor:
Date of Hire:
Date of Last Review:
BEHAVIORS AND SKILLS
Circle the statement that best describes the employee's behaviors and skill levels. Please note that at the initial
assessment most performance is expected to be mid-range, even when employees are performing well, as they
are still learning about their jobs and the agency.
1) JOB KNOWLEDGE: The extent to which employee understands his or her job and has the
knowledge necessary to fulfill job responsibilities.
1
2
Does not have the
knowledge to
perform present
work at satisfactory
level. Needs
training in several
areas.
Knowledge of job
in limited.
Required frequent
direction and
information to
perform job duties.
3
4
5
Understands job and
uses knowledge
appropriately to
perform job duties.
Above average job
knowledge
consistently applied
in performance of
job duties.
Understands all
phases of job.
Has expert
knowledge of the
job. Seeks
additional
knowledge and
applies such to
improve the team’s
work.
COMMENTS:
2) JUDGMENT: Approach used to make timely and cost-effective decisions; ability to think and act in
logical and calm manner. Understanding which issues to act on alone and which need consultation
with others.
1
2
3
4
5
Jumps to
conclusions. Lacks
ability or confidence
to make decisions
on daily activities or
makes inappropriate
decisions.
Judgment is usually
acceptable in daily
decisions. Not
always able/willing
to use logical
approach to
decision making.
Generally
demonstrates logical
thinking and makes
found decisions.
Uses analytical
approach to decision
making.
Consistently makes
sound decisions.
Applies thought and
analysis to decision
making process
Displays
exceptional ability
to analyzes
situations and make
sound decision even
in complex or
difficult situations.
COMMENTS:
Rev. 3/23/09
1
3) INITIATIVE: Capacity for independent action, completion of tasks despite obstacles; ability to find
new ways to accomplish goals.
1
2
3
4
5
Waits for
instructions and
assignments. Not
able to work
independently.
Easily discouraged if
obstacles arise.
Rarely a self -tarter.
Needs frequent
supervision. May
solve simple
problems
independently.
Often a selfstarted. Can solve
daily problems on
own, but may need
help with special
projects and
problems.
A self-starter, often
finds new ways to
accomplish goals.
Persistent. Takes
independent action
when needed.
Self-starter in all
areas. Consistently
finds new ways to
accomplish goals.
Excels in problemsolving.
COMMENTS:
4) QUALITY OF WORK: Accuracy, thoroughness, amount of work accomplished and time taken.
1
2
3
4
5
Unable to meet
minimum job
requirements.
Quality/quantity of
work unacceptable.
Meets only
minimum
standards.
Meets requirements.
Assignments
accomplished in an
effective manner.
Assignments are
done thoroughly
and on time.
Exceeds
expectations.
Produces tangible
results that are will
above job
expectations.
COMMENTS:
5) ORGANIZATION AND TIME MANAGEMENT: Ability to plan and organize work and meet
project timelines.
1
2
3
4
5
Shows lack of
organization and
poor time
management skills.
Misses deadlines,
poor recordkeeping.
May understand the
value of planning
and organization,
but is unable to do
so consistently.
Effective under most
circumstances. May
need assistance for
new or difficult
assignments.
Well organized.
Good time
management skills.
Consistently
finishes
assignments in
timely manner.
Productive and
well-organized.
Meets timeliness
even when
confronted with
problems or
obstacles.
COMMENTS:
Rev. 3/23/09
2
6) COMMUNICATION: Ability to communicate effectively with internal and external contacts, both
orally and in writing (letters, policies, newsletter articles, informational materials, grants).
1
2
3
4
5
Lacks clarity,
Unable to
communicate
effectively with
others whether
orally, writing, or
both.
Limited skills. Oral
communication
unclear and/or
written work needs
extensive editing.
Typically gets
point across both in
oral and written
form. Written
work may need
some editing.
Clear and easily
understood. Needs
only minor editing
of written work.
Well-spoken, clear
and persuasive.
Excellent written
materials, no
editing required.
COMMENTS:
7. ACCOUNTABILITY: Responsibility assumed by employee for his or her own actions and
assignments; ability to acknowledge and rectify individual errors. Ability to see that work gets done
even in adverse circumstances.
1
2
3
4
5
Requires constant
supervision. Daily
work must be
monitored closely.
Not always
dependable. Carries
out responsibilities,
but requires close
supervision.
Generally
dependable. Carries
out responsibilities
with some
supervision.
Dependable.
Consistently carries
out responsibilities.
Required minimal
supervision.
Required almost no
supervision. Can
be relied upon in
all work situations
and at all times.
COMMENTS:
8. ADAPTABILITY & FLEXIBILITY: Versatility; ability to carry out new/different assignments or
work in new ways.
1
2
3
4
5
Unable or unwilling
to adjust to new
assignments or
procedures.
Has some difficulty
in adapting to
change.
Flexible in most
cases and able to
adapt to change.
Consistently flexible
and adaptable.
Can adjust to any
situation. Does
whatever is needed
to get the job done.
COMMENTS:
Rev. 3/23/09
3
9. TEAMWORK AND WORK RELATIONS: Ability to work effectively and cooperatively with coworkers and supervisors.
1
2
3
4
5
Inability to work
with others.
Frequent conflicts.
Complains and
criticizes coworkers to others.
Usually works well
with others.
Occasional
conflicts.
Active team
participant, minimal
conflicts, accepts
constructive
criticism.
Effective team
member, resolves
conflicts, works
cooperatively and is
open to criticism.
Trusted and
respected by others.
Seeks constructive
criticism and uses in
positive manner.
COMMENTS:
10. KNOWLEDGE OF AGENCY POLICIES & PROCEDURES: Knowledge of and adherence to
agency and program policies and procedures related to employee's job responsibilities.
1
2
3
4
5
Lacks thorough
understanding of
agency policies and
procedures; does
not implement them
Some understanding
of policies and
procedures, but
inconsistent
implementation
Understands and
consistently
implements
policies and
procedures.
Thoroughly
understands and
thoughtfully
implements
policies and
procedures.
Thorough
understanding and
thoughtful
implementation.
Suggests appropriate
revisions.
COMMENTS:
11. ATTENDANCE/PUNCTUALITY: Attendance, arrival and departure times.
1
Excessively absent,
tardy or unavailable
for work.
2
Inconsistent, has
occasional difficulty
with attendance or
punctuality.
3
Regular attendance,
notified in advance
or tardiness,
absence or use of
earned leave.
4
5
Consistently present
and on time.
Timely notification
of absences or use
of earned leave.
Almost perfect
attendance and
punctuality.
Schedules absences
and use of earned
leave in advance
and plans for backup.
COMMENTS:
12. CUSTOMER SERVICE: Responsive to customer needs, professional and respectful, makes customer
service a priority.
1
Does not respond to
customers in a
timely manner. May
display irritation
when confronted
with a “difficult”
customer.
2
Inconsistent in
responding to
customers’ needs.
Responds well to
some people and
issues, less well to
others.
3
Consistently and
respectfully meets
customers’ needs.
COMMENTS:
Rev. 3/23/09
4
4
Makes customer
service a priority.
Creative in solving
customer problems.
Delivers difficult
messages with tact
and respect.
5
Advocates for our
customers. Goes
above and beyond
to see that
customers’ needs
are met.
Please complete for all staff assessments based on the scores of all items rated on the preceding pages.
OVERALL RATING
Total Score:

# of items scored:
= Overall Rating:
GOALS
Achievement of Previous Goals. (if applicable)
Please list each goal that was set at previous appraisal and whether employee achieved, exceeded, or failed to
reach to goal. Explain any situations or conditions that may have impacted the goal attainment.
Goal 1:
Goal Progress (check one)
Did Not Achieve Goal
Partially Achieved Goal
Achieved Goal
Exceeded Goal
Comments
Goal 2:
Goal Progress (check one)
Did Not Achieve Goal
Partially Achieved Goal
Achieved Goal
Exceeded Goal
Comments
Goal 3:
Goal Progress (check one)
Did Not Achieve Goal
Partially Achieved Goal
Achieved Goal
Exceeded Goal
Comments
Goal 4:
Goal Progress (check one)
Did Not Achieve Goal
Partially Achieved Goal
Achieved Goal
Exceeded Goal
Rev. 3/23/09
Comments
5
New Goals. Please list 2-4 goals for the upcoming year and your plans to achieve them. Goals may be
similar or different from those above. Describe any preparation or training needed to achieve the goals
and perspective time line. Goals should be Specific, Measurable, Attainable, Realistic and Time Specific
(SMART).
New Goal 1:
Plan to achieve :
New Goal 2:
Plan to achieve :
New Goal 3:
Plan to achieve :
New Goal 4:
Plan to achieve :
Supervisor’s Comments:
Employee’s Comments:
I have read this assessment and reviewed it with my supervisor. My signature does not imply agreement with
the content of this assessment, only receipt.
______________________________________________
________________________
Employee's Signature
Date
______________________________________________
Supervisor's Signature
Rev. 3/23/09
6
________________________
Date