Instructions
You are invited to provide feedback for the employee listed above.
Providing feedback is an important responsibility. Feedback is intended to support the receiver’s success in his or her role and to be useful, i.e. - information that the receiver can understand and apply. In providing your feedback, please consider your experiences with this individual during the last twelve months.
Your feedback will be summarized with others’ in a report for the staff member and his or her supervisor to use in support of their development and successful performance. The responses remain anonymous. Please note that the "comments" provided in the final report will be reported exactly as written, without identifying information.
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Communication Skills |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Problem Solving |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Decision Making |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Accountability |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Interpersonal Skills |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Developing Others |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Leadership |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Supervisory Skills |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Teamwork |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Trustworthy |
Needs Significant Development 1 |
2 | Would Benefit from Development 3 |
4 | Capable and Efficient 5 |
6 | Role Model 7 |
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If were to make improvements in the area listed above, which item do you think should be emphasized most over the next year in order to improve their performance. | |||||||
Improvement needed in number: | |||||||
Please offer suggestions on how this can be improved. | |||||||
Closing Comments
Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
Overall, how would you rate your job performance and why?
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What do you like most about working with .
What do you like least about working with .
Other Comments:
Status of the Form
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