Completing the Self Appraisal Form - Supervisor / Manager and Office Professional

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)
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.

Performance Against Key Performance Indicators (on Supervisor/Manager and Office Professional
forms only)

5)      List each objective that was established for the employee to concentrate on during the review
period. If none currently exist take from duties listed in Job Description or Agree at the beginning of
the process 5 Key indicators rlated to the performance of the position which the employee occupies.

6)      Beside each objective, indicate a descriptor that best suits your performance of those objectives

Key Performance Indicators for next review period (on Supervisory/Professional forms only)
7)   Identify 5 Key Performance Indicators that you think are important for your position for the next
review period.

Overall Ratings Section

8)      The Overall Rating Score will be automatically calculated and should be showing in the boxes, one
rating score is for performance against Performance Categories (out of 50), the second is for
performance against individual KPI's, (out of 25).If not enter the scores manually.
For the overal score out of 100 the rating for performance against KPI's is multiplied by 2 and added to
the rating for performance against Performance Categories
Comments Section

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

Development Opportunity Section

10)  Identify where you see an opportunity for development during the next review period that will
improve your current performance
11)  Identify any training that could help you achieve greater performance.

Signature Date Section

12)  Sign and date the Self Appraisal Form with the date completed.
 EMPLOYEE SELF APPRAISAL 2012/13
SUPERVISOR / MANAGER AND OFFICE PROFESSIONAL
Name:
Title:
Review Period:
to
1 TOTAL SAFETY PERFORMANCE CATEGORIES
1 Unwavering commitment to Safety
2 Unwavering commitment to Quality
3 We are Responsive to the needs of our clients and employees
4 Our Teamwork enables us to lead the industry
5 Individual Integrity is the foundation of everything we do
3 PERFORMANCE AGAINST KPI'S
1 TOTAL SAFETY PERFORMANCE CATEGORIES
Performance What This Means to
Category Total Safety
[Click on circle and
Rate the employee on the following scale 1 to 5
We share an unwavering commitment to
safety. Total Safety is dedicated to
identifying, correcting, and preventing
Safety
1 health, safety, and environmental hazards,
which could adversely affect our
employees, our customers, or the general
public. Please Choose
Quality is the fiber that binds all of our
efforts around the globe. Total Safety's
reputation is built on the quality of service
we provide. Our goal is to provide high-
2 Quality quality safety solutions in a measurable,
cost-effective manner, without
compromise.
We are responsive to the needs of our
clients and employees. We readily react
3 Responsive appropriately to their suggestions,
influences, appeals, or efforts.
Our teamwork enables us to lead the
industry. We work well as part of a team
Teamwork
4 and share ideas and information. We
establish positive working relationships
throughout the organization.
Individual integrity is the foundation of
everything we do. Our teammates
Trust & Integrity
5 knowing we will do the right things and
make good decisions; Our customers
knowing that we will to do right by them.
2 INDIVIDUAL PERFORMANCE CATEGORIES
Performance What This Means to
Category Total Safety
Our staff is one of the most qualified within
the industry. No one has more capability,
1 Technical Skills and no one does it better.
Comprehensive, competitive and reliable
– that’s Total Safety.
Total Safety employees are accountable
for their time and therefore strive to be as
2 Productivity efficient
and productive as possible.
Manager Name:
Region: International (Please Select from Drop Down)
Location: Insert Location
Review Due Date: Date of Joining
2 INDIVIDUAL PERFORMANCE CATEGORIES
1 Technical Ability
2 Productivity
3 Flexibility and Agility
4 Resourcefulness
5 Customer Focus
4 KPI'S FOR NEXT REVIEW PERIOD
Does not meet Sometimes Exceeds Continuously Exceeds
Score Requirements Needs Improvement Meets Expectations Expectations Expectations
select score from
1 2 3 4 5
drop down.]
Consistently follows safe Champions all HSE initiatives by
Demonstrates "at risk Provides positive intervention
Occasionally follows safe work practices and supports providing leadership that directly
behavior" and will not follow
work practices Total Safety's safety
and coaches others to perform
impacts the safety culture
safe work practices safe work
initiatives Evidence Required
Rating
Continuously seeks ways to
Occasionally meets Consistently meets improve productivity and
Lets project details slip; Maintains a persistent focus on
objectives; Reports objectives; Follows work effectiveness; Proactively raises
Consistently provides quality as well as on results;
sometimes have errors; processes; Notices critical issues that impact quality
incorrect data causing
Occasionally lacks attention mistakes in his or her own
Helps to determine how to
and takes the lead in resolving
problems for others who improve productivity and
to the critical issues and work and takes corrective them; Encourages others to suggest
depend on that information effectiveness
details action improvements
Please Choose Evidence Required
Rating
Makes timely decisions Has the confidence to make
Is complacent; Consistently Occasionally does not
based on the best available Tackles problems or conflict decisions in uncertain
does not follow through on follow through on
information; Consistently head on; Seeks information circumstances; Always takes the
commitments; Usually does commitments; Occasionally
not support the team when does not support the team
follows through on rather than waiting for it; initiative to identify and solve work-
commitments to clients and Maintains a sense of urgency to related problems; Enables others to
additional work is needed to when additional work is
team; Does not complete a task be responsive
meet deadlines needed to meet deadlines
Please Choose procrastinate Evidence Required
Rating
Lays blame, points fingers, Works well as part of a team Respects and responds to others’
Doesn't always follow Is able to work across
scrutinizes other members; and shares ideas and ideas and opinions; Builds on the
through on commitments workgroups; Shares information
Does not give credit to information; Puts forth suggestions of team members;
and generally doesn't as appropriate; Fills in for
teammates; Does not additional effort when Encourages the exchange of
support the team when teammates and takes
support team decisions, nor
additional work is needed;
necessary to help team
ownership as if tasks were their
productive ideas; Helps resolve
contribute to the team; Does reach goals; Maintains a team conflicts; Adjusts own actions
Does not readily share all own; Looks for additional ways
not volunteer for positive attitude toward and approach as necessary to help
relevant information with to help out team; Seeks out
assignments; Does not peers and supervisors; Has the group achieve its goals
other team members other initiatives
participate in meetings a pitch-in attitude Evidence Required
Please Choose
Rating
Is focused on doing the right
Sometimes gets caught in Assumes responsibility for Always behave in a way that is
Is not focused on doing the thing for our customer and
playing games for personal dealing with problems or consistent with the organization's
right thing for the customer teammates; Maintains
gain; Encourages gossip or issues; Takes the initiative to values and principles; Continuously
and teammates; Does not confidentiality; Keeps
maintain confidentiality;
shares inappropriate
promises and honors
provide all relevant information, promotes a positive company image
information; Is inconsistent even when communicating through his/her actions and
Misuses company time for commitments;
in communicating about a about a problem, mistake, or communication
personal business Demonstrates consistency
problem other difficult situation Evidence Required
Please Choose between words and actions
Rating
Does not meet Sometimes Exceeds Continuously Exceeds
Score Requirements Needs Improvement Meets Expectations Expectations Expectations
Has some but not all of the
Proactively helps others learn
technical skills necessary to Has knowledge of all Has comprehensive knowledge
systems; Is knowledgeable about
be fully effective in his or technologies relevant to of all technologies relevant to
best practices relative to the
Is unable to technically her current job; Is resistant his/her job responsibilities; his/her job responsibilities;
perform his or her job to assimilating new Quickly masters new Helps others learn technical
technical aspects of his/her
function/role and benchmarks
technical knowledge technical knowledge matters related to his/her role or
against other organizations
relevant to his or her relevant to his/her position function
Evidence Required
Please Choose position
Rating
Employee consistantly surpases
Regularly produces more work
Consistantly produces very Employee shows effort in expectation for volume, quality and
Produces the work required at additional effort than what is
little work or tends to be their attempts to produce delivery of work within expected
of their position in the time- expected for the position.
consistantly late in meeting the work expected of them timelines. Shows inititive in
timelines for work. Engages but regularly fails to meet
scale required and of an Employee is pro-active in
identifying and completing
acceptable standard of finding additional duties to
in non work activities during expectation in terms of work additional duties for the benefit of
quality. complete and does so at a high
work hours volume. their team and the Company.
standard.
Please Choose Evidence Required
Rating
 Performance What This Means to Does not meet Sometimes Exceeds Continuously Exceeds
Category Total Safety Score Requirements Needs Improvement Meets Expectations Expectations Expectations

[Click on circle and

Rate the employee on the following scale 1 to 5 select score from
1 2 3 4 5
drop down.]

Anticipates changes in the internal

Is occasionally unable to Works and collaborates
and external environment (Ex:
Total Safety is as flexible as our change working style to effectively in unstructured or
organizational, market, products
customers need us to be. We routinely Is consistently unwilling to align to project needs; Is open to new methods, dynamic environments;
and systems) and adapts
customize our programs to meet our take on any job challenge; Is Frequently has difficulties ideas, or approaches; Considers new ways of
Flexibility and accordingly; Leads change effort
3 Agility
customer’s varied requirements. We pride consistently resistant to handling new developments Adapts his/her behavior in approaching issues and
and removes obstacles that prohibit
ourselves in being mobile and flexible. change or slow to recognize or assignments without response to new information modifies course of action when
change;
the need to change assistance; Is occasionally or changing circumstances necessary. Challenges the
Willingly helps others adapt to
unwilling to change ideas status quo.
change
based on new information.
Please Choose Evidence Required
Rating

Is resistant to change when

Quickly responds to unforeseen Views failures and mistakes as an
We have a variety of customers with a Does not actively support the external/internal Looks for different ways to
changes in the business; opportunity to learn; Routinely finds
variety of needs. Our employees meet changes or new ideas; Often environment poses new seek information and to
Consistently projects credibility ways to overcome or eliminate
Resourcefulnes our customer's needs and/or solve their becoming an obstacle to challenges or satisfy a request or
4 s complex problems by acting effectively or change; Uses a single constraints; Introduces less complete a project;
and poise under difficult or barriers that are hindering
adverse conditions; Bounces achievement of the organizational
imaginatively, especially in difficult formula or process for every new programs/initiatives Remains focused,
back from failures or goals
situations. problem than what was needed or composed and optimistic
disappointments Evidence Required
required
Please Choose
Rating

Responds to a customer’s Effectively manages customer

Is consistently not available
We do it right. That’s the only way we Is unable to make things inquiry or problem in a expectations (Ex: reshapes Seeks out and consistently uses
for customers during regular
service our customers. We make happen for the customer timely and effective manner; incorrect/inappropriate information about customers as the
working hours; Does not take
understanding our customer's business, because of inability to work Follows up on customer assumptions, establishes basis of problem solving, decision
routine or required customer
Customer needs and expectations a top priority. We through internal politics or requests to ensure that the realistic timeframes, pushes making, and organizational action;
5 Focus demonstrate that concern for their
actions to meet customer
bureaucracy; Does not final product or service met back as necessary); Seeks Promotes approaches which may
needs; Does not return
business, needs and expectations by provide customers with the customer's expectations; information about underlying be new or different from those
customer calls or research
delivering exceptional customer service. alternatives/solutions to Conveys realistic needs of the customer, beyond requested by the customer because
their problems; Misleads
meet their needs expectations to internal and those needs expressed initially they better meet customer needs
customers
external customers by the customer
Please Choose
Rating

3 PERFORMANCE AGAINST KEY PERFORMANCE INDICATORS

Meets
Description of Key Performance Indicator Expectations comments

1
Please Choose Rating

2
Please Choose Rating

3
Please Choose Rating

4
Please Choose Rating

5
Please Choose Rating

4 KEY PERFORMANCE INDICATORS FOR NEXT REVIEW PERIOD

Description of Key Performance Indicator comments

EVALUATION RATING

Employee Overall Rating (Times

Employee rating for
Employee rating for KPI's KPI rating x 2 & add score out of
Performance Categories:
50)

Out of 50 #VALUE! Out of 25 #VALUE! Out of 100 #VALUE!

Employee Comments on Rating - Provide Examples to support your evaluation including successful contributions and achievements over the last year.

Development Opportunities
Identify areas for development during the next review period.
Identify competencies that you would like to improve and in what way. Include what training and learning opportunities you would like to have:

What obstacles are in the way of you achieving your performance objectives? What are you planning to overcome these obstacles? What actions can your Supervisor and/or the
Company take to help remove these inhibitors?

Signature

Employee Date