Employee self appraisal form

Self-evaluation form  Your name ___________________________________________________________ Position __________________ Date of employment...

Self-evaluation form 

Your name ___________________________________________________________ Position __________________ Date of employment ____________How long in present position: Years______________ Months ___________________ Attendance record Number of days absent this year ___________Approved days __________ Unauthorized days ______________________ Number of days absent last year ___________Approved days __________ Unauthorized days ______________________ Number of days late this year __________________ Number of days late last year _______________________________ Attendance is (check one): ❏ Excellent ❏ Good ❏ Poor Work performance In sections A through E, rate your job performance by circling a number

A. Quality of work
1—Consistently produce extremely neat and accurate work. Require minimum supervision.
2—Work is very neat and accurate. Require little supervision.
3—Quality of work is good. Make few mistakes.
4—Produce work that is passable, although quality needs improvement.
5—Make frequent errors; frequently produce work that is not acceptable. Comments:_______________________________________ _______________________________________________

B. Quantity of work
1—Superior work production record. Frequently complete job ahead of schedule.
2—Very good producer. Meets schedules on all assignments. Do more than required.
3—Volume of work is satisfactory. Most assignments completed on time.
4—Require close supervision in order to complete assignment on time.
5—Very slow. Seldom complete assignments in required time. Comments:_______________________________________ _______________________________________________

C. Job knowledge
1—Understand all phases of work. Completely mastered duties and carry them out skillfully.
2—Have very good knowledge of job functions and perform them well.
3—Understand most job functions. Require minimum supervision.
4—Show understanding of job but require help and instruction in some phases of work.
5—Lack sufficient understanding of job functions to perform duties effectively. Comments:_______________________________________ _______________________________________________

D. Staff relations
1—Go out of way to cooperate and assist. Work very well with others.
2—Willing to provide assistance. Alert to needs of others. Quick to respond.
3—Work well with others and takes direction. Cooperative.
4—Usually cooperative. May occasionally exhibit problems in this area.
5—Poor attitude. Unfriendly and uncooperative in contacts with others. Comments:_______________________________________ _______________________________________________

E. Patient and client relations
1—Extremely good in dealing with people. Goes out of the way to be helpful and courteous.
2—Consistently very good with patients. Leave them with a good feeling towards the office.
3—Deal effectively with patients.
4—Attitude and behavior not consistently effective.
5—Frequently rude or blunt. Lack tact. Comments:_______________________________________ _______________________________________________
List: Four essential items that you’re doing well.
1.)______________________
2.) ______________________
3.)______________________
4.) ______________________
Four essential items that need improvement:
1.)______________________
2.) ______________________
3.)______________________
4.) ______________________
Your signature ________________________________________________________________ Date ________________

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