PERFORMANCE PARTNERSHIP – Self-Assessment Form
Human Resources, Skytop Office Building, 443-2488
Form Introduction:
Staff members are encouraged to complete this form prior to the performance feedback meeting with his/her
supervisor to help ensure an interactive discussion. This Self-Assessment form should not to be submitted to HR as the
final Performance Partnership documentation.
This form is locked with limited editing and formatting capabilities. Use either the tab key or click directly on a gray area
to complete this form. Further instructions can be found on the Performance Partnership web page at
http://humanresources.syr.edu/staff/nbu_staff/perform_sec4.html.
Staff Member Name Staff Member SUID #
Supervisor Name
Section 1: Accomplishments
List your accomplishments and the impact/results noted during this review period.
Section 2: Job Related Competencies
Check three to five General competencies from the list below that you feel are important for your job success.
If you are a manager or a supervisor, choose two to three additional Leadership competencies.
Of those competencies chosen, denote which ones you feel are strengths and which ones you feel could be
developed further. Provide some explanation.
During the review discussion with your supervisor it is recommended that you both come to agreement on the
three to five competencies and edit the final review form as needed.
Access the definition of each competency by using your mouse to select the word and then pressing Ctrl + Left Click to
follow the link.
General Competencies Leadership
Adaptability Initiative Change Leadership
Attention to Detail Innovation Coaching
Caring Negotiation Collaborative Leadership
Collaboration Organizational Understanding Conflict Management
Communication: Open Planning & Organizing/Time Management Influence
Communication Oral and/or Written Problem Solving Team Leadership
Continuous Learning Professionalism
Crisis Management Quality
Discernment/Judgment Reliability
Diversity Service
Drive for Results Technical Expertise
Of the competencies selected, which are your strengths? Provide explanation and/or examples.
In the spirit of continuous improvement, which of the competencies selected will you aim to develop during the next
review period? Provide explanation and/or examples.
HR409 – Page 1 Initiated Mar-03; Updated Jan-07; Feb-09; Dec-09
PERFORMANCE PARTNERSHIP – Self-Assessment Form
Human Resources, Skytop Office Building, 443-2488
Section 3: Goals/Development Opportunities
Identify three or more goals and/or development opportunities for the next performance review period. Goals may be:
newly assigned expectations and projects, assignments that develop employee potential outside of daily job duties,
improvements to execution of current responsibilities. Developmental goals may include: training or learning
experiences designed to improve the employee’s knowledge, or skills that the employee will utilize during the next
review period. The Goals and Development Worksheet can be used at the discretion of the supervisor and/or employee
to track progress throughout the next review period.
Defined Goal/Development Identified Outcomes Targeted Completion Date
You have now completed the Self-Assessment form. This form should be saved and forwarded electronically to your
supervisor in order to initiate the formal review process.
Note the date that the Self-Assessment form was submitted to your immediate supervisor:
HR409 – Page 2 Initiated Mar-03; Updated Jan-07; Feb-09; Dec-09