Confidential Employee Performance Review Employee ...

Confidential Employee Performance Review
Employee Name_____________________________ Date of review ________________
Job Title: ____________________________Date entered position _________________
Type of Review: Annual Quarterly Probationary
Performance Rating Table:
0=Unsatisfactory; 1=Marginal/Needs Improvement; 2=Acceptable; 3=Above Average; 4=Outstanding
Rating
Supporting Comments
Job Knowledge: Demonstrates understanding of objectives,
duties, and responsibilities in accordance with the job description;
takes initiative to learn and do more.
Technical Skills: Proficiency in use of methods, tools, equipment,
and other materials necessary to accomplish work; work is neat
and legible.
Problem solving: Ability to handle conflict, knows how to correct
a problem, performs well under pressure, accepts changes in
routine and procedures willingly.
Work Organization/Time Management: Ability to accomplish
work assignments in an orderly, timely and practical manner;
ability to manage time by establishing priorities and developing
work plans; does share of workload.
Service Orientation: Employee demonstrates a friendly and
courteous disposition with patients, co-workers, and supervisors;
respectful of other person’s opinions.
Attitude/Cooperation: Amount of interest and enthusiasm shown
in work; extent to which employee promotes a cooperative, team
environment with co-workers.
Dependability/Adaptability: Extent to which employee can be
counted on to be on the job, carry out instructions, remains flexible
to change, workload and assignments; fulfills responsibilities;
performs with minimal supervision.
Initiative: Ability to be self-directed, take appropriate action, and
be efficient, resourceful, and creative in attaining job objectives.
Judgment: Extent to which decisions and actions are based on
sound reasoning and weighing of outcomes in support of
organizational goals and priorities.
Written/Oral Communication: Demonstrated ability for selfexpression
with clarity, accuracy, attention to detail.
Attendance: Maintains a good attendance record for personal
and developmental reasons; recognizes the importance of good
attendance and punctuality for the workflow and productivity of the
department.
Professionalism: The professional manner in which employee
conducts self; shows interest in job and patients, maintains
discreetness and confidentiality; neatness and cleanliness of
appearance.
SOS Healthcare Management Solutions, LLC – Page 1 of 2
www.soshms.com

Confidential Employee Performance Review
Additional comments:
Identify and comment on the employee's principal strengths and significant achievements/special assignments during
the review period.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Identify and comment on circumstances (e.g., lack of resources, conditions in the workplace environment) that may
have had a positive or negative impact on the employee's performance.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Identify and comment on areas of performance requiring improvement, and record specific steps to be taken:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Our Merit Pay Improvement Program
Staff is periodically eligible for base pay increases as indicated by demonstrated individual performance through our
Merit Pay Improvement Program. Employee must achieve a performance rating of 30 or greater to be considered for
merit pay increase.
Total rating achieved at this review: ________ Merit Raise Awarded Yes No
I have discussed this review with the employee
Reviewer _____________________________________
Date______________________________
I have read and understand this employee review and received a copy of it
Employee_____________________________________
Date______________________________
Next review scheduled for: _____________________________________________________________
SOS Healthcare Management Solutions, LLC – Page 2 of 2
www.soshms.com