SCHOOL OF MEDICINE
PERFORMANCE APPRAISAL FORM -- SUPERVISORS
Additional performance appraisal resources are located on the Human Resource Group (HRG) website at http://hrg.stanford.edu/.
Name Position Title
Period of Evaluation
Exceptional (E) Achieves results that consistently exceed most or all objectives and expectations. Notable, visible, and
excellent contributions are widely recognized in the organization. Demonstrates outstanding initiative and
creativity, and produces high-impact results and demonstrates desirable behaviors.
Successful (S) Consistently meets and sometimes exceed all objectives and expectations. Produces or exceeds expected
results while demonstrating expected behaviors. Solid contributions are recognized in the organization.
Learning (L) Is making progress and continues to learn key aspects of the job. Performance meets many, but is
inconsistent in meeting all performance objectives and behavioral expectations. Improvement and/or
Unsatisfactory (U) May have met some performance objectives but overall failed to meet performance and behavioral
expectations. Immediate action is required to improve performance and/or behavior.
I. A. COMPETENCIES: Complete ratings for competencies and add any additional competencies for this
specific job (i.e. leadership, flexibility, planning).
U L S E
1. Builds and Maintains Relationships: Encourages cooperation when developing teams; demonstrates
appropriate interpersonal skills; establishes/maintains productive, respectful working relationships.
2. Demonstrates Required Job Knowledge: Full working knowledge of procedures and systems; takes initiative
to ensure skills are current, understands the business and establishes clear priorities for actions.
3. Communicates Effectively: Presents ideas in a thoughtful and compelling manner; communicates effectively
and respectfully; seeks to understand the differing sides of situations; uses emerging technology effectively.
4. Displays Accountability: Accepts responsibility for work; monitors progress and results; dependable and self-
reliant; acknowledges mistakes; maintains confidentiality with sensitive information.
5. Drives Quality and Excellence: Demonstrates commitment to deliver high quality work; attentive to detail;
continuously seeks process improvement; committed to personal excellence.
6. Makes Decisions Effectively and Decisively: Seeks out and considers relevant information; makes sound
decisions based upon analysis, experience and judgment; decisive and takes action; sought out by others for advice
7. Diversity/Respectfulness: Demonstrates commitment and leadership in recruiting, retaining and promoting
qualified candidates; provides employees with fair, timely, and regular feedback; works to create staff work-life
balance; utilizes resources to encourage and increase staff development.
8. Additional Competency, if desired (see Performance Management tab at http://hrg.stanford.edu/ for list of
Met Not Met
9. Compliance and Health & Safety: Demonstrates commitment to a healthy and safe environment; takes steps
to correct hazardous conditions promptly; complies with training and education to meet regulatory and compliance
requirements. (review training record/report annually: http://obi.stanford.edu)
I. B. RESPONSIBILITIES & GOALS: List job goals and responsibilities (from the “Duties and
Responsibilities” section of the position summary and/or goals and responsibilities set last year).
U L S E
II. OVERALL EVALUATION AND SUPERVISOR COMMENTS:
Include areas of strength & for improvement. Consider all the ratings in Section IA and IB and give an overall
rating below. The overall rating need not be an average of all ratings--take into consideration the essential and
most important job duties when selecting the overall rating. Unsatisfactory rating requires comment.
U L S E
OVERALL RATING (check one)
III. EMPLOYEE COMMENTS & FEEDBACK TO SUPERVISOR: Allow reasonable time for the employee to complete this
section and return to the supervisor. Additional pages may be attached if necessary.
IV. EMPLOYEE AND SUPERVISOR MUTUALLY ESTABLISH JOB DEVELOPMENT GOALS: Set goals for coming
year that will be evaluated at the end of the next performance review cycle.
V. SIGNATURES: Place a signed, completed copy in the employee’s Department Personnel File. A signature does not necessarily
imply agreement with the content of the appraisal.
Employee Signature: Date:
Supervisor(s) Signature: Date:
Manager Signature: (optional) Date:
Revised February 2012 page 2