
Distribution:               Original – Human Resources               Copy – Supervisor               Copy - Employee   
STAFF PERFORMANCE APPRAISAL FORM 
 
 
NAME: _________________________________________________ EMPLOYEE ID NO: __________________________ 
 
DEPARTMENT: ___________________________________ CLASSIFICATION TITLE: ___________________________ 
 
TYPE OF APPRAISAL: 
         ANNIVERSARY            SPECIAL 
 
A
PPRAISAL PERIOD:                  FROM: __________________________ TO: ____________________________ 
 
This form must be returned to the Division of Human Resources by ________________. If the form is not received by this 
date, rating will automatically default to Achieves Performance Standards. 
 
INSTRUCTIONS: This appraisal form must be completed by the immediate supervisor 
based on performance standards previously established.  If the selected category is 
“Achieves Standards” the supervisor must indicate the level of rating: M=Marginal or P= 
Proficient.  If the overall is Achieves Standards Marginal or Below Standards, the 
supervisor must contact the Employee and Labor Relations Department for assistance in 
implementing a Performance Improvement Plan. 
EXCEEDS 
STANDARDS 
ACHIEVES 
STANDARDS 
BELOW 
STANDARDS
JOB KNOWLEDGE: 
     
QUALITY OF WORK: 
     
PRODUCTIVITY: 
     
DEPENDABILITY: 
     
ATTENDANCE: 
     
RELATIONS WITH OTHERS: 
     
COMMITMENT TO SAFETY: 
     
SUPERVISORY ABILITY: (applicable only to designated supervisor 
positions) 
     
OVERALL APPRAISAL RATING: (one CATEGORY must BE 
CHECKED) 
     
 
M
P