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University of California, Davis OFFICE OF ADMINISTRATION EMPLOYEE PERFORMANCE APPRAISAL REPORT Period covered (month/day/year): from to Employee Name Department Payroll Title / Title Code Working Title Employee Number $ Personnel Program (MSP, PSS, or Collective Bargaining Unit) Monthly Salary/Step/%Range % DaFIS Account Number(s) Percent appointment This employee has been supervised by me for the full review period (check one): YES NO If the answer is no, how long have you supervised this employee? JOB-RELATED PERFORMANCE DURING THE REVIEW PERIOD: (Add sheets if needed.) The following narrative describes this employee’s overall job-related performance, based upon the employee’s position description/job functions, OOA core competencies, attainment of established goals and overall contributions to the department/unit mission. Also include any comments relative to employees activities related to safety in the work place. SUPERVISOR’S ASSESSMENT: Meets or Exceeds Expectations (For merit purposes only, this is interpreted as “Satisfactory or better”.) Does Not Meet Expectations (This is equal to less than “Satisfactory”.) University of California, Davis I - 14 OFFICE OF ADMINISTRATION EMPLOYEE PERFORMANCE APPRAISAL REPORT Employee name Review Date Page SPECIAL APPRAISAL CATEGORIES (Check box and attach comments on separate sheet or incorporate in the narrative section.) Supervisory Skills: recruitment/selection, employee development, setting performance expectations/performance appraisal, leadership and delegation, communication with staff. Equal employment opportunity and affirmative action: job-related commitment to good faith efforts in recruitment, training. Safety: applicable to those employees who have specific safety-related department/campus responsibilities noted in the position description. Other: EMPLOYEE COMMENTS (optional) Attach additional sheet if needed. SIGNATURES Employee: I have read and received a copy of this evaluation. Date Immediate Supervisor: Date Note to employee: Your signature indicates neither agreement nor disagreement with the appraisal, but indicates that you have read the appraisal and it has been discussed with you. If you wish, you may comment in the space above and attach an additional sheet if needed. NEXT-HIGHER-LEVEL REVIEW: All information on this report has been discussed with the employee. Do you concur with the supervisor’s appraisal/assessment of the employee? YES NO If you don’t concur, please attach a statement specifying the areas in which you disagree. Other comments pertinent to the appraisal/assessment may be provided as well. _________________________________________________________________________________ Signature Date NEXT-HIGHER-LEVEL REVIEW (If applicable) _________________________________________________________________________________ Signature Title Date University of California, Davis I - 24 OFFICE OF ADMINISTRATION EMPLOYEE SUMMARY OF ACCOMPLISHMENTS Period covered (month/day/year): from to Employee name Department The objective of this summary is to provide an opportunity to reflect upon the results of this past year’s activity, ensure agreement with your supervisor regarding accomplishments, and strengthen communication regarding future goals and priorities for the coming year. Attach additional sheets as needed. Describe: 1. Accomplishments related to your job functions and applicable special appraisal category 2. Accomplishments related to established individual or team goals and/or performance expectations aligned with the Balanced Scorecard Perspectives; Customer, Financial, Innovation and Learning and Internal Business. 3. Equal employment opportunity and affirmative action activities. 4. Training and development received. Employee Signature DateUniversity of California, Davis OFFICE OF ADMINISTRATION I - 34 FUTURE GOALS AND/OR PERFORMANCE EXPECTATIONS For Appraisal Period: from to For the next appraisal period Include individual or team goals consistent with the Balanced Scorecard Perspectives; Customer, Financial, Innovation and Learning and Internal Business. These goals are expected to align with the department/unit-shared goals and mission. Specific goals intended to help improve performance and performance standards also may be included. SUPERVISORY SUPPORT: This section documents specific action steps or areas of support to be provided by the supervisor to enable achievement of the above stated goals. I - 44
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