Completing the Self Appraisal Form - Non- Supervisory / Operational

Note: The purpose of the self assessment is to give the employee an opportunity to
objectively think about his/her own performance and to provide information to the manager to
assist in an accurate performance review. In addition, the self assessment provides an
opportunity for open communication about the employee’s performance during the
performance discussion session.

Employee Data Section

1) Enter the review period (From date of last review to current review date, usually 1 year)
2)      Complete the appropriate fields with your name, your title, joining date, your manager’s name and
insert the appropriate region and location.

Performance Categories Section

3)      For each of the performance indicators listed, determine which of the descriptors best describe
your performance. The descriptors are designed to describe what it would take to meet, exceed or not
meet expectations in that category.
1 = Does Not Meet Minimum Requirements
2 = Needs Improvement to Meet Expectations
3 = Meets Expectations
4 = Continuously Meets and Sometimes Exceeds Expectations
5 = Continuously Exceeds Expectations
4)      Once you have identified the best fit descriptor, enter the number of that descriptor in the circle by
clicking first on the cell and then selecting the correct number from the drop down list.

Overall Ratings Section

5)      The Overall Rating Score will be automatically calculated and should be showing in the box
The Overall Rating Score is out of 50

Comments Section

6)    Support your Overall Rating Score with examples of your performance in the Comments Section

Development Opportunity Section

7)    Identify where you see an opportunity for development during the next review period that will
improve your current performance

8)    Identify training you think would assist your performance or development within the Company.

Signature Date Section

9)    Sign and date the Self Appraisal Form with the date completed.
 EMPLOYEE SELF APPRAIS
NON-SUPERVISORY / OPE
Name: Manager Name:

Position: Region: Internation

Location:

Review Period: Review Due Da

to

1 TOTAL SAFETY PERFORMANCE CATEGORIES 2 INDIVIDUAL

1 Unwavering commitment to Safety 1 Technical Ability
2 Unwavering commitment to Quality 2 Productivity
3 We are Responsive to the needs of our clients and employees 3 Flexibility and A
4 Our Teamwork enables us to lead the industry 4 Resourcefulnes
5 Individual Integrity is the foundation of everything we do 5 Customer Focus

1 TOTAL SAFETY PERFORMANCE CATEGORIES

Performance What This Means to Does not meet Needs

Category Total Safety Score Requirements Improveme

[Click on circle and

Rate the employee on the following scale 1 to 5 select score from 1 2
drop down.]

Total Safety is dedicated to

identifying, correcting, and
preventing health, safety, and
Safety
1 environmental hazards, which
could adversely affect our
employees, our customers, or the
general public.
Demonstrates "at risk
Occasionally follo
behavior" and will not follow
work practic
safe work practices
Please Choose
Rating
 Performance What This Means to Does not meet Needs
Category Total Safety Score Requirements Improveme

[Click on circle and

Rate the employee on the following scale 1 to 5 select score from 1 2
drop down.]

Total Safety's reputation is built

Occasionally m
on the quality of service we Lets project details slip;
objectives; Re
provide. Our goal is to provide Consistently provides
sometimes have
2 Quality high-quality safety solutions in a incorrect data causing
Occasionally la
measurable, cost-effective problems for others who
attention to the c
manner, without compromise. depend on that information
issues and det

Please Choose
Rating

Is complacent; Consistently Occasionally do

We are responsive to the needs of
does not follow through on follow through
our clients and employees. We
commitments; Usually commitments; Occ
3 Responsive readily react appropriately to their
does not support the team does not support t
suggestions, influences, appeals,
when additional work is when additional w
or efforts.
needed to meet deadlines needed to meet de
Please Choose
Rating

Lays blame, points fingers,

Doesn't always
scrutinizes other members;
Our teamwork enables us to lead through on comm
Does not give credit to
the industry. We work well as part and generally do
teammates; Does not
of a team and share ideas and support the team
4 Teamwork information. We establish
support team decisions, nor
additional work is
contribute to the team;
positive working relationships Does not readily s
Does not volunteer for
throughout the organization. relevant informati
assignments; Does not
other team mem
participate in meetings

Please Choose
Rating

Sometimes gets c
Individual integrity is the Is not focused on doing the
playing games for
foundation of everything we do. right thing for the customer
gain; Encourages g
Trust & Integrity Our teammates knowing we will and teammates; Does not
5 do the right things and make good maintain confidentiality;
shares inapprop
information; Is inco
decisions; Our customers knowing Misuses company time for
in communicating
that we will to do right by them. personal business
problem

Please Choose
Rating
 Performance What This Means to Does not meet Needs
Category Total Safety Score Requirements Improveme

[Click on circle and

Rate the employee on the following scale 1 to 5 select score from 1 2
drop down.]

2 INDIVIDUAL PERFORMANCE CATEGORIES

Has some but not

Our staff is one of the most technical skills ne
qualified within the industry. No to be fully effective
one has more capability, and no Is unable to technically her current job; Is
1 Technical Skills one does it better. perform his or her job to assimilating
Comprehensive, competitive and technical knowl
reliable – that’s Total Safety. relevant to his o
position
Please Choose
Rating

Consistantly produces very Employee shows

Total Safety employees are little work or tends to be their attempts to p
accountable for their time and consistantly late in meeting the work expected
2 Productivity therefore strive to be as efficient timelines for work. Engages but regularly fails
and productive as possible. in non work activities during expectation in te
work hours work volum

Please Choose
Rating

Is occasionally un
change working s
Total Safety is as flexible as our
align to project n
customers need us to be. We Is consistently unwilling to
Frequently has dif
routinely customize our programs take on any job challenge;
handling ne
Flexibility and to meet our customer’s varied Is consistently resistant to
3 Agility requirements. We pride ourselves change or slow to
developments
assignments w
in being mobile and flexible. recognize the need to
assistance; Is occa
change
unwilling to chang
on new informat
different adv
Please Choose
Rating

Is resistant to chan
We have a variety of customers
Does not actively support the external/int
with a variety of needs. Our
changes or new ideas; environment pos
employees meet our customer's
Often becoming an challenges
4 Resourcefulness needs and/or solve their complex
obstacle to change; Uses a constraints; Introdu
problems by acting effectively or
single formula or process new programs/ini
imaginatively, especially in difficult
for every problem than what was ne
situations.
required
Please Choose
Rating
 Performance What This Means to Does not meet Needs
Category Total Safety Score Requirements Improveme

[Click on circle and

Rate the employee on the following scale 1 to 5 select score from 1 2
drop down.]

We do it right. That’s the only way Is consistently not available

we service our customers. We for customers during Is unable to make
make understanding our regular working hours; happen for the cu
customer's business, needs and Does not take routine or because of inability
expectations a top priority. We required customer actions through internal po
5 Customer Focus demonstrate that concern for their to meet customer needs; bureaucracy; Do
business, needs and expectations Does not return customer provide custome
by delivering exceptional calls or research their alternatives/solut
customer service. problems; Misleads meet their ne
customers

Please Choose
Rating

EVALUATION RATING
Employee Overall Rating: (From Employee Self-Evaluation,
#VALUE! Out of 50)
Employee Comments on Rating - Provide Examples to support your evaluation

Development Opportunity
Identify areas for development during the next review period.
What areas of performance can you develop or improve?

Identify training you believe will be beneficial to your performance:

Signature

Employee Date
Performance What This Means to Does not meet Needs
Category Total Safety Score Requirements Improveme

[Click on circle and

Rate the employee on the following scale 1 to 5 select score from 1 2
drop down.]
RAISAL 2012-13
OPERATIONAL

ternational (Please Select from Drop Down)

(Insert Location)

w Due Date: Date of Joining

VIDUAL PERFORMANCE CATEGORIES

cal Ability
tivity
ity and Agility
cefulness
mer Focus

Continuously Exceeds
eeds Meets Sometimes Exceeds Expectations - Evidence
mprovement Expectations Expectations Required

2 3 4 5

Champions all HSE

Consistently follows safe Provides positive
initiatives by providing
onally follows safe work practices and intervention and coaches
leadership that directly
ork practices supports Total Safety's others to perform safe
impacts the safety culture
safety initiatives work
Evidence Required
 Continuously Exceeds
eeds Meets Sometimes Exceeds Expectations - Evidence
mprovement Expectations Expectations Required

2 3 4 5

Continuously seeks ways

to improve productivity and
asionally meets Consistently meets Maintains a persistent
effectiveness; Proactively
ctives; Reports objectives; Follows work focus on quality as well as
raises critical issues that
mes have errors; processes; Notices on results; Helps to
impact quality and takes the
asionally lacks mistakes in his or her own determine how to improve
lead in resolving them;
ion to the critical work and takes corrective productivity and
Encourages others to
es and details action effectiveness
suggest improvements
Evidence Required

Has the confidence to make

Makes timely decisions
sionally does not Tackles problems or decisions in uncertain
based on the best
ow through on conflict head on; Seeks circumstances; Always takes
available information;
ments; Occasionally information rather than the initiative to identify and
Consistently follows
t support the team waiting for it; Maintains a solve work-related problems;
through on commitments
additional work is sense of urgency to Enables others to be
to clients and team; Does
to meet deadlines complete a task responsive
not procrastinate
Evidence Required

Respects and responds to

Is able to work across
Works well as part of a others’ ideas and opinions;
n't always follow workgroups; Shares
team and shares ideas Builds on the suggestions of
h on commitments information as
and information; Puts forth team members; Encourages
enerally doesn't appropriate; Fills in for
additional effort when the exchange of productive
rt the team when teammates and takes
necessary to help team ideas; Helps resolve team
al work is needed; ownership as if tasks were
reach goals; Maintains a conflicts; Adjusts own
ot readily share all their own; Looks for
positive attitude toward actions and approach as
nt information with additional ways to help
peers and supervisors; necessary to help the group
team members out team; Seeks out other
Has a pitch-in attitude achieve its goals
initiatives
Evidence Required

Is focused on doing the Always behave in a way that

Assumes responsibility for
mes gets caught in right thing for our is consistent with the
dealing with problems or
games for personal customer and teammates; organization's values and
issues; Takes the initiative
courages gossip or Maintains confidentiality; principles; Continuously
to provide all relevant
es inappropriate Keeps promises and promotes a positive
information, even when
ion; Is inconsistent honors commitments; company image through
communicating about a
municating about a Demonstrates consistency his/her actions and
problem, mistake, or other
problem between words and communication
difficult situation
actions Evidence Required
 Continuously Exceeds
eeds Meets Sometimes Exceeds Expectations - Evidence
mprovement Expectations Expectations Required

2 3 4 5

Proactively helps others

me but not all of the
Has comprehensive learn systems; Is
al skills necessary Has knowledge of all
knowledge of all knowledgeable about best
y effective in his or technologies relevant to
technologies relevant to practices relative to the
ent job; Is resistant his/her job responsibilities;
his/her job responsibilities; technical aspects of his/her
ssimilating new Quickly masters new
Helps others learn function/role and
nical knowledge technical knowledge
technical matters related benchmarks against other
ant to his or her relevant to his/her position
to his/her role or function organizations
position
Evidence Required

Employee consistantly
Regularly produces more surpases expectation for
ee shows effort in work at additional effort volume, quality and delivery
Produces the work
empts to produce than what is expected for of work within expected
required of their position
k expected of them the position. Employee is timelines. Shows inititive in
in the time-scale required
ularly fails to meet pro-active in finding identifying and completing
and of an acceptable
tation in terms of additional duties to additional duties for the
standard of quality.
ork volume. complete and does so at a benefit of their team and the
high standard. Company.
Evidence Required

Anticipates changes in the

sionally unable to
Works and collaborates internal and external
e working style to
effectively in unstructured environment (Ex:
o project needs;
Is open to new methods, or dynamic environments; organizational, market,
ntly has difficulties
ideas, or approaches; Considers new ways of products and systems) and
andling new
Adapts his/her behavior in approaching issues and adapts accordingly; Leads
velopments or
response to new modifies course of action change effort and removes
nments without
information or changing when necessary. obstacles that prohibit
ce; Is occasionally
circumstances Challenges the status change;
g to change based
quo. Willingly helps others adapt
w information or
to change
ferent advice
Evidence Required

Quickly responds to
ant to change when Views failures and mistakes
unforeseen changes in
xternal/internal Looks for different ways to as an opportunity to learn;
the business; Consistently
nment poses new seek information and to Routinely finds ways to
projects credibility and
hallenges or satisfy a request or overcome or eliminate
poise under difficult or
nts; Introduces less complete a project; barriers that are hindering
adverse conditions;
ograms/initiatives Remains focused, achievement of the
Bounces back from
hat was needed or composed and optimistic organizational goals
failures or
required Evidence Required
disappointments

eeds Meets
mprovement Expectations
2 3
Responds to a customer’s
inquiry or problem in a
ble to make things
timely and effective
n for the customer
manner; Follows up on assumptions, establishes
of inability to work
customer requests to
internal politics or
ensure that the final
ucracy; Does not
product or service met the
e customers with
customer's expectations;
tives/solutions to
Conveys realistic
et their needs
expectations to internal
and external customers needs expressed initially
Continuously Exceeds
Sometimes Exceeds Expectations - Evidence
Expectations Required
4 5
Effectively manages
Seeks out and consistently
customer expectations
uses information about
(Ex: reshapes
customers as the basis of
incorrect/inappropriate
problem solving, decision
making, and organizational
realistic timeframes,
action; Promotes
pushes back as
approaches which may be
necessary); Seeks
new or different from those
information about
requested by the customer
underlying needs of the
because they better meet
customer, beyond those
customer needs
Evidence Required
by the customer
 Continuously Exceeds
eeds Meets Sometimes Exceeds Expectations - Evidence
mprovement Expectations Expectations Required

2 3 4 5