Non-Supervisory Evaluation Form - DOC by F0VftI

VIEWS: 208 PAGES: 5

									                                                                  PERFORMANCE EVALUATION FORM
                                                                                   (Non-Supervisory)

Employee Name:                                                                SSN:

      Position Title:                                                      Division:

     Rating Period:            From:                          Location:
                                                            To:
                                                Department of Health Mission
                   To promote and protect the health and safety of all people in Florida through the delivery of
                          quality public health services and the promotion of health care standards.
                                                   OVERALL PERFORMANCE EVALUATION
       5 Outstanding        4 Exceeds                                  3 Meets                   2 Needs        1 Below Expectations
                          Expectations                              Expectations             Improvement
        Expectations/Standards/                                   Appraisal Rating              Comments required for ratings 5 or 1
            Competencies
Work Products – Produces reports, correspondence,            5    4   3   2    1       N/A
and other work products which meet the intended
objectives, demonstrate professional competency, and
reflect acceptable quality.
Teamwork and Cooperation – Works cooperatively               5    4   3   2    1       N/A
with others, keeps others informed of necessary and
factual information; and works together as opposed to
working separately. Facilitates the operation of a
team of which he/she is part and fosters teamwork
across work units.
Initiative– Thinks ahead of the present to act on            5    4   3   2    1       N/A
future needs and opportunities. Identifies problems,
obstacles, or opportunities and takes action to
address issues.
Commitment to Agency – Strives to meet high                  5    4   3   2    1       N/A
standards through reducing the burden on those
served, continually improving the business practices,
producing results, and working to improve processes.
Relationships – Develops and maintains effective             5    4   3   2    1       N/A
working relationships with others. Treats customers,
the public, and staff with courtesy, respect, dignity,
fairness, honesty, and presents a positive public
image. Handles emotions of self and others well,
maintains self-confidence, and controls emotional
reactions.
Communication – Communicates clearly, listens                5    4   3   2    1       N/A
effectively; keeps others informed of necessary and
factual information; deals effectively with conflict, and
avoids negative gossip.
Technical Skills – Demonstrates knowledge of                 5    4   3   2    1       N/A
methods, techniques, and skills required in own and/or
related     functions;   applies    specific  methods,
procedures, and techniques in functional area.
Dependability – Reliable, completes assignments in           5    4   3   2    1       N/A
a timely manner, follows through on assignments, and
pulls his/her own weight.
Conceptual       Skills    –   Conceptualizes  the           5    4   3   2    1       N/A
organization’s relationship with other entities;
understands organizational sub-unit relationships
and dependencies; acts accordingly.
Managing Change – Initiates change effectively and           5    4   3   2    1       N/A
adapts to necessary changes in operations; and has a
positive attitude towards operational changes.

Problem Analysis/Solving – Analyzes problems                 5    4   3   2    1       N/A
comprehensively, makes timely, practical decisions,
understands        cause-and-effect     chains    and
relationships, and identifies possible solutions.
Self-Direction – Arranges work for the most efficient        5    4   3   2    1       N/A
handling and eliminates unnecessary activities; uses
time effectively; acts independently.

Presentations - Develops clear well-organized and            5    4   3   2    1       N/A
logical presentations; reduces complex issues to
simple terms; is sensitive to audience level.

Impact and Influence - Uses deliberate influence             5    4   3   2    1       N/A
strategies or tactics to persuade or convince others to
support department agendas, and promotes the
mission and values of the department.
Totals for Core Expectations (Optional)




        Employee: _______________________________________________                                              Page 1 of 5
  Use this section for Job Specific                              Appraisal Rating           Comments required for ratings 5 or 1
                                                                                          (Provide comments regarding the rate of appraisal and
PHN Core Competencies                                                                      potential resources for development to the next level)
Analytic/Assessment Skills
Aware:                                                       5   4   3   2   1      N/A
  Defines a problem.
  Identifies relevant and appropriate data and
   information sources.









Knowledgeable:                                               5   4   3   2   1      N/A
  Determines appropriate uses and limitations of
   both quantitative and qualitative data.
  Selects and defines variables relevant to defined
   public health problems.
  Evaluates the integrity and comparability of data
   and identifies gaps in data sources.
  Makes relevant inferences from quantitative and
   qualitative data.
  Recognizes how the data illuminates ethical,
   political, scientific, economic, and overall public
   health issues









Proficient:                                                  5   4   3   2   1      N/A
   Applies ethical principles to the collection,
    maintenance, use, and dissemination of data and
    information.
   Obtains and interprets information regarding risks
    and benefits to the community.
   Partners with communities to attach meaning to
    collected quantitative and qualitative data.
   Applies data collection processes, information
    technology applications, and computer systems
    storage/retrieval strategies









Policy Development/Program Planning Skills
Aware:                                                       5   4   3   2   1      N/A
  States policy options and concise policy
   statements.
  Identifies, interprets, and implements public
   health laws, regulations, and policies related to
   specific programs.
  Utilizes current techniques in decision analysis
   and health planning.
  Decides on the appropriate course of action.
  Assists in preparation and implementation of the
   all hazards response plans.









Knowledgeable:                                               5   4   3   2   1      N/A
  Collects, summarizes, and interprets information
   relevant to an issue.
  Develops a plan to implement policy, including
   goals, outcome and process objectives, and
   implementation steps.
  Prepares and implements all hazards response
   plans.









Proficient:                                                  5   4   3   2   1      N/A
   Articulates the health, fiscal, administrative, legal,
    social, and political implications of each policy
    option.
   States the feasibility and expected outcomes of
    each policy option.
   Translates policy into organizational plans,
    structures, and programs.
   Develops mechanisms to monitor and evaluate
    programs for their effectiveness and quality.












         Employee: _______________________________________________                                                Page 2 of 5
Communication Skills
Aware:                                                  5   4   3   2   1   N/A
  Communicates effectively both in writing and
   orally, or in other ways.
  Listens to others in an unbiased manner,
   respects points of view of others, and promotes
   the expression of diverse opinions and
   perspectives.









Knowledgeable:                                          5   4   3   2   1   N/A
  Solicits input from individuals and organizations.
  Advocates for public health programs and
   resources.
  Leads and participates in groups to address
   specific issues.
  Effectively presents accurate demographic,
   statistical, programmatic, and scientific
   information for professional and lay audiences.









Proficient:                                             5   4   3   2   1   N/A
   Uses the media, advanced technologies, and
    community networks to communicate information.










Cultural Competency Skills
Aware:                                                  5   4   3   2   1   N/A
  Recognizes appropriate methods for interacting
   sensitively, effectively, and professionally with
   persons from diverse cultural, socioeconomic,
   educational, racial, ethnic and professional
   backgrounds, and persons of all ages and
   lifestyle preferences.
  Recognizes the role of cultural, social, and
   behavioral factors in determining the delivery of
   public health services.









Knowledgeable:                                          5   4   3   2   1   N/A
  Utilizes appropriate methods for interacting
   sensitively, effectively, and professionally with
   persons from diverse cultural, socioeconomic,
   educational, racial, ethnic and professional
   backgrounds, and persons of all ages and
   lifestyle preferences.
  Identifies the role of cultural, social, and
   behavioral factors in determining the delivery of
   public health services.
  Understands the dynamic forces contributing to
   cultural diversity.









Proficient:                                             5   4   3   2   1   N/A
   Develops and adapts approaches to problems
    that take into account cultural differences.
   Understands the importance of a diverse public
    health workforce.










Community Dimensions of Practice Skills (or Community Involvement)
Aware:                                                  5   4   3   2   1   N/A
  Identifies how public and private organizations
   operate within a community.
  Identifies community assets and available
   resources.













        Employee: _______________________________________________                 Page 3 of 5
Knowledgeable:                                             5   4   3   2   1   N/A
  Utilizes leadership, team building, negotiation,
   and conflict resolution skills to build community
   partnerships.
  Collaborates with community partners to promote
   the health of the population.
  Accomplishes effective community engagements.
  Describes the role of government in the delivery
   of community health services.









Proficient:                                                5   4   3   2   1   N/A
   Establishes and maintains linkages with key
    stakeholders.
   Develops, implements, and evaluates a
    community public health assessment.










Basic Public Health Sciences Skills
Aware:                                                     5   4   3   2   1   N/A
  Understands the historical development,
   structure, and interaction of public health and
   health care systems.
  Demonstrates a commitment to lifelong learning









Knowledgeable:                                             5   4   3   2   1   N/A
  Identifies the individual's and organization's
   responsibilities within the context of the Essential
   Public Health Services and core functions.
  Defines, assesses, and understands the health
   status of populations, determinants of health and
   illness, factors contributing to health promotion
   and disease prevention, and factors influencing
   the use of health services.
  Identifies and applies information collection
   methodology used in public health.
  Applies the basic public health sciences including
   behavioral and social sciences, biostatistics,
   epidemiology, environmental public health, and
   prevention of chronic and infectious diseases and
   injuries.









Proficient:                                                5   4   3   2   1   N/A
   Identifies and retrieves current relevant scientific
    evidence.
   Identifies the limitations of research and the
    importance of observations and interrelationships.










Financial Planning and Management Skills
Aware:                                                     5   4   3   2   1   N/A
  Applies budget processes.
  Applies basic human relations skills to the
   resolution of conflicts.
  Manages information systems for collection,
   retrieval, and use of data for decision-making.









Knowledgeable:                                             5   4   3   2   1   N/A
  Manages programs within budget constraints.
  Monitors program performance.
  Applies basic human relations skills to the
   management of organizations and motivation of
   personnel.













        Employee: _______________________________________________                    Page 4 of 5
Proficient:                                                5   4   3   2    1   N/A
   Develops and presents a budget.
   Develops strategies for determining budget
    priorities.
   Prepares proposals for funding from external
    sources.
   Negotiates and develops contracts and other
    documents for the provision of population-based
    services.
   Conducts cost-effectiveness, cost-benefit, and
    cost-utility analyses.










Leadership and Systems Thinking Skills
Aware:                                                     5   4   3   2    1   N/A
  Supports a culture of ethical standards within
   organizations and communities.
  Helps create key values and shared vision and
   uses these principles to guide action.
  Promotes team and organizational learning.









Knowledgeable:                                             5   4   3   2    1   N/A
  Identifies internal and external issues that may
   impact delivery of essential public health services
   (i.e., strategic planning).
  Contributes to development, implementation, and
   monitoring of organizational performance
   standards.
  Applies theory of organizational structures to
   professional practice.









Proficient:                                                5   4   3   2    1   N/A
   Facilitates collaboration with internal and external
    groups to ensure participation of key
    stakeholders.
   Uses the legal and political system to effect
    change.










Employee Development Plan: (Describe the specific type of training the employee should attend during this evaluation period.)

Performance Plan Approval

Employee Signature                                  Date               Supervisor Signature            Date



Final Evaluation Comments and Signatures

Comments:



Immediate Supervisor’s Signature:                                                     Date:
Comments:


Reviewer’s Signature:                                                                 Date:
Comments:



Employee’s Signature:                                                                 Date:

        Revised: January 2004


        Employee: _______________________________________________                                    Page 5 of 5

								
To top