Policies and Procedures Manual
Staff Performance Evaluation
Policy No. 05:17:00
Appendix B
Page 1 of 8
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COLUMBIA STATE COMMUNITY COLLEGE
PROFESSIONAL STAFF
PERFORMANCE EVALUATION
Employee Name
Job Title
Department
yrs
Service Date
Please mark one:
3-month Evaluation
Time on current Job
Evaluation From
6-month Evaluation
Annual Evaluation
Evaluation To
Other
The primary objective of this performance evaluation is for improvement of employee performance and
recognition of exemplary performance. The care and accuracy with which this evaluation is prepared will
determine its value to the employee, to the employer and to the College. It should encourage open discussion
between the supervisor and the employee with respect to job requirements, job expectations, job performance,
areas of needed improvement, and overall performance of duties.
For the Employee: As part of the Performance Evaluation Policy, the following are your rights and obligations
as an employee.
You have the right:
 to expect a fair and objective evaluation
 to expect a confidential evaluation
 to discuss with your supervisor methods for improving your job skills and/or performance and
development
 to be given an adequate amount of time to review your evaluation prior to signing and returning the
evaluation to your supervisor
 to discuss your evaluation with your second level supervisor, if needed
 to be given a copy of your final evaluation
You have an obligation:

to actively participate in the evaluation process

to request explanations of ratings with which you disagree

to seek the guidance and advice of your supervisor toward strengthening job performance

to comment in writing on your evaluation and sign the evaluation form
By no means is this form an all-inclusive document. It should, by including comments and examples, prompt the
kind of performance evaluation and follow-up discussions that go into creating a healthy and productive work
environment.
Revised 5/15
Policies and Procedures Manual
Staff Performance Evaluation
Policy No. 05:17:00
Appendix B
Page 2 of 8
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Supervisor Instructions: For each category listed, please indicate the category that most closely describes the
performance of the employee. Categories below “Performs Position Expectations” require documentation.
IMPORTANT: DO NOT USE PENCIL OR ERASABLE INK!
PERFORMANCE RATING SCALE SUMMARY
Performs Position
Expectations
Demonstrates a level of accomplishment that clearly meets all expectations.
Reflects performance expected of those who possess the necessary
education, training, and experience to perform the job in a consistently
reliable manner.
Needs Improvement
Demonstrates a level of accomplishment below expected standards of
performance. Demonstrates an inconsistent level of achievement due to lack
of commitment, focus, and/or initiative to put forth full effort.
Unacceptable
Performance is clearly below minimum job requirements. Performance in
the area will be re-evaluated in 90 days.
Not applicable
Does not apply to job.
Commendations/Notations
This is where outstanding performance can be recognized and/or
improvements activities noted.
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Policies and Procedures Manual
Staff Performance Evaluation
Policy No. 05:17:00
Appendix B
Page 3 of 8
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ORGANIZATION & TIME MANAGEMENT
To what extent does the employee identify priorities and schedules? To what extent does the employee
set and meet deadlines for reports, plans, budget, etc. To what extent does the employee effectively
organize, plan ahead and make efficient use of time and resources?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
INITIATIVE
To what extent does the employee move ahead on own initiative, initiate action and find workable
solutions to problems? To what extent does the employee demonstrate awareness of procedural and
technical changes in carrying out job functions? To what extent does the employee demonstrate
resourcefulness and willingness to accept responsibility?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
PERCEPTION & JUDGMENT
To what extent does the employee display ability to secure and evaluate facts in making decisions and
taking action? To what extent does the employee weigh information objectively and unemotionally and
reach logical, timely and effective decisions?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
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Policies and Procedures Manual
Staff Performance Evaluation
Policy No. 05:17:00
Appendix B
Page 4 of 8
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COMMUNICATION
To what extent does the employee use acceptable standards of English, including punctuation,
grammar, sentence structure, and spelling – both orally and in writing?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
ADAPTABILITY & FLEXIBILITY
To what extent does the employee adapt to new situations and changes in routines, work load, and / or
work assignments? To what extent is the employee able to adjust to changing circumstances in order to
get the job done? To what extent is the employee able to do various types of work?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
DEPENDABILITY
To what extent does the employee adhere to policies and procedures? To what extent is the employee
reliable in performing assigned duties without direct supervision? To what extent does the employee
maintain satisfactory attendance performance in regard to tardiness, early departures and / or absences?
To what extent does the employee follow leave policies? To what extent is needed information shared
in a timely manner with supervisors, associates, employees and others?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
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Policies and Procedures Manual
Staff Performance Evaluation
Policy No. 05:17:00
Appendix B
Page 5 of 8
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PROFESSIONAL QUALITIES
To what extent does the employee exhibit ethical standards and integrity, and demonstrate courtesy
and fairness in dealing with others? To what extent does the employee effectively participate in
professional activities, such as organizations, publications, development, team and committee
meetings, and community service? Is the image projected by the employee an asset to the college?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
JOB KNOWLEDGE / SKILLS
To what extent does the employee maintain a satisfactory level of job knowledge and / or skills,
demonstrate an understanding of work assignments, and exercise skills appropriate to meet the
expectations of the position?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
QUALITY AND QUANTITY OF WORK
To what extent does the employee’s work meet necessary quality standards; example – accuracy,
neatness, thoroughness, compliance with safety standards? To what extent does the employee meet
acceptable work load standards and accomplish the quantity of work expected?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
Revised 5/15
Policies and Procedures Manual
Staff Performance Evaluation
Policy No. 05:17:00
Appendix B
Page 6 of 8
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ATTITUDE / RELATIONSHIPS
To what extent does the employee display a positive, cooperative team attitude toward work
assignments and requirements? To what extent does the employee establish effective working
relationships when dealing with supervisors, those being supervised (if applicable), co-workers, and /
or the public? To what extent does the employee display a positive attitude toward criticisms and
suggestions?
Check One
Performs Position Expectations
Commendations/Notations
Click
here
to
enter
text.
☐
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
SUPERVISORY SKILLS (IF APPLICABLE)
To what extent does the employee demonstrate progress in reaching diversity goals outlined in the
affirmative action plan and other-race student enrollment? To what extent is the employee able to
obtain the cooperation of others, inspire confidence, teamwork and commitment and effectively direct
the work effort of others to accomplish goals and meet challenges? To what extent does the employee
motivate, delegate responsibility, evaluate staff, monitor work and actively recognize and reward the
accomplishments of others? To what extent does the employee promote effective and efficient area
operation, budget management, and planning and management for the responsible area?
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
Not Applicable
☐
OVERALL PERFORMANCE
Check One
Performs Position Expectations
Commendations/Notations
☐ Click here to enter text.
Needs Improvement
☐
Unacceptable
☐
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Policies and Procedures Manual
Staff Performance Evaluation
Policy No. 05:17:00
Appendix B
Page 7 of 8
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Goals for the next performance cycle:
Outline goals for professional development, continuous improvement and strategic plan as pertains to
position:
Click here to enter text.
Performance Improvement Plan: (applicable to individuals receiving a “Needs Improvement” or an
“Unacceptable” rating) Write a performance improvement plan that outlines changes or actions to be
completed to receive a performance rating of “Performs Position Expectations.”
Click here to enter text.
Each supervisor is to complete a review of the position description for each position prior to completion of the
performance review for the purpose of alignment of current responsibilities and actions. Any identified changes
are to be discussed with the appropriate vice president / president and a correct position description forwarded to
the Office of Human Resources. (Check all that apply.)
Yes, the position description was reviewed for update prior to the performance review.
No changes were identified.
Changes were identified and have been reviewed and approved by the vice president/president.
Changes have been forwarded to the Office of Human Resources.
Changes have been reviewed with the employee.
Supervisor’s Signature
Date
The performance review is to be reviewed with the second level supervisor prior to the supervisor meeting with the
employee:
Second Level Supervisor’s Signature
Date
Second Level Supervisor Comments:
Click here to enter text.
Revised 5/15
Policies and Procedures Manual
Staff Performance Evaluation
Policy No. 05:17:00
Appendix B
Page 8 of 8
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EMPLOYEE RESPONSE OR COMMENTS
Please use this space to respond to this evaluation. This response may include agreement /
disagreement, reasons for certain scores, or plans of action for the upcoming year. [Attach additional
sheet(s), if necessary].
Employee Signature
Date
Revised 5/15