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# 

# **Performance Review**

+---------------+-----------+----------------+--------+--------------+
| **Personal    |           |                |        |              |
| Data**        |           |                |        |              |
+---------------+-----------+----------------+--------+--------------+
| Employee ID   | Employee  |                | Job    |              |
|               | Name      |                | Title  |              |
+---------------+-----------+----------------+--------+--------------+
| Div           | Reviewer  |                | Review |              |
| ision/Section |           |                | Period |              |
+---------------+-----------+----------------+--------+--------------+
| **Performance |           | **Results and  |        | **Ratings**  |
| Goals and /   |           | Acc            |        |              |
| or Job        |           | omplishments** |        |              |
| Res           |           |                |        |              |
| ponsibilities |           |                |        |              |
| (Elements)**  |           |                |        |              |
+---------------+-----------+----------------+--------+--------------+
| A performance |           | Evaluate       |        | Select one   |
| goal is a     |           | results        |        | rating for   |
| statement of  |           | against        |        | each         |
| results to be |           | mutually       |        | performance  |
| achieved in a |           | established    |        | goal or job  |
| given review  |           | performance    |        | re           |
| period. Goals |           | goals and job  |        | sponsibility |
| are project   |           | res            |        | (element).   |
| or            |           | ponsibilities. |        |              |
| target-based. |           |                |        |              |
| A job         |           |                |        |              |
| r             |           |                |        |              |
| esponsibility |           |                |        |              |
| (element) is  |           |                |        |              |
| a requirement |           |                |        |              |
| that must be  |           |                |        |              |
| met on an     |           |                |        |              |
| ongoing       |           |                |        |              |
| basis. Job    |           |                |        |              |
| res           |           |                |        |              |
| ponsibilities |           |                |        |              |
| define        |           |                |        |              |
| routine tasks |           |                |        |              |
| or essential  |           |                |        |              |
| functions.    |           |                |        |              |
+---------------+-----------+----------------+--------+--------------+
| 1\.           |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+
| 2\.           |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+
| 3\.           |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+
| 4\.           |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+
| 5\.           |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+
| 6\.           |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+
| 7\.           |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+
| 8\.           |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+
| 9\.           |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+
| 10\.          |           |                |        | \_\_\_       |
|               |           |                |        | Outstanding  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Excellent    |
|               |           |                |        |              |
|               |           |                |        | \_\_\_       |
|               |           |                |        | Commendable  |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Meets |
|               |           |                |        | expectations |
|               |           |                |        |              |
|               |           |                |        | \_\_\_ Does  |
|               |           |                |        | not\         |
|               |           |                |        | meet         |
|               |           |                |        | expectations |
+---------------+-----------+----------------+--------+--------------+

  -------------------------- -------------- -----------------------------------------------------
  **Core Competencies**                     **Competency Ratings**

  Select one rating for each                
  competency                                

  Initiative and Creativity  \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  Judgment                   \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  Cooperation/Teamwork       \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  Quality of Work            \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  Reliability                \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  Commitment to Safety       \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  Support of Diversity       \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  **Job-specific                            
  Competencies                              
  (Optional)\***                            

                             \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

                             \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

                             \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

                             \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

                             \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

                             \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  **Managerial/Supervisory                  
  Competencies (For                         
  employees who supervise                   
  others)**                                 

  Leadership                 \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  Decision Making            \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  Resource Management        \_\_           
                             Outstanding    
                             \_\_ Excellent 
                             \_\_           
                             Commendable    
                             \_\_ Meets     
                             expectations   
                             \_\_ Does not  
                             meet           
                             expectations   

  **Summary of Performance                  
  and Review of                             
  Competencies**                            

                                            

  **Career Development Plan                 
  (Optional)**                              

                                            
  -------------------------- -------------- -----------------------------------------------------

+-------------+---+-------------+----+-------+--------------+------------+
| **S         |   |             |    |       |              |            |
| ignatures** |   |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| **Employee  |   |             |    |       |              |            |
| Ackn        |   |             |    |       |              |            |
| owledgement |   |             |    |       |              |            |
| of          |   |             |    |       |              |            |
| Performance |   |             |    |       |              |            |
| Goals/Job   |   |             |    |       |              |            |
| Respo       |   |             |    |       |              |            |
| nsibilities |   |             |    |       |              |            |
| and         |   |             |    |       |              |            |
| Com         |   |             |    |       |              |            |
| petencies** |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| My          |   |             |    |       |              |            |
| supervi     |   |             |    |       |              |            |
| sor/manager |   |             |    |       |              |            |
| and I       |   |             |    |       |              |            |
| identified  |   |             |    |       |              |            |
| and         |   |             |    |       |              |            |
| discussed   |   |             |    |       |              |            |
| my          |   |             |    |       |              |            |
| performance |   |             |    |       |              |            |
| goals, job  |   |             |    |       |              |            |
| respo       |   |             |    |       |              |            |
| nsibilities |   |             |    |       |              |            |
| and         |   |             |    |       |              |            |
| job-related |   |             |    |       |              |            |
| c           |   |             |    |       |              |            |
| ompetencies |   |             |    |       |              |            |
| at the      |   |             |    |       |              |            |
| beginning   |   |             |    |       |              |            |
| of the      |   |             |    |       |              |            |
| review      |   |             |    |       |              |            |
| period.     |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| Employee    |   |             |    |       |              |            |
| Signature   |   |             |    |       |              |            |
| \_\_\       |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| Date        |   |             |    |       |              |            |
| \_\_\_\_\   |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| **Progress  |   |             |    |       |              |            |
| Review      |   |             |    |       |              |            |
| (           |   |             |    |       |              |            |
| Optional)** |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| My          |   |             |    |       |              |            |
| supervi     |   |             |    |       |              |            |
| sor/manager |   |             |    |       |              |            |
| and I       |   |             |    |       |              |            |
| discussed   |   |             |    |       |              |            |
| my          |   |             |    |       |              |            |
| p           |   |             |    |       |              |            |
| erformance. |   |             |    |       |              |            |
| We have     |   |             |    |       |              |            |
| updated     |   |             |    |       |              |            |
| goals/job   |   |             |    |       |              |            |
| respo       |   |             |    |       |              |            |
| nsibilities |   |             |    |       |              |            |
| and         |   |             |    |       |              |            |
| co          |   |             |    |       |              |            |
| mpetencies\ |   |             |    |       |              |            |
| (if         |   |             |    |       |              |            |
| needed).    |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| Employee    |   |             |    |       |              |            |
| Signature   |   |             |    |       |              |            |
| \_\_\       |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| Date        |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| **Overall   |   | **Employee  |    | **Emp |              |            |
| Rating**    |   | ID:**       |    | loyee |              |            |
|             |   |             |    | Na    |              |            |
|             |   |             |    | me:** |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| **Select    |   |             |    |       |              |            |
| only one    |   |             |    |       |              |            |
| rating**    |   |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| \_\_\_ Does | \ |             | \_ |       | \_\_\_       | \_\_\_     |
| not meet    | _ |             | \_ |       | Excellent +  | O          |
| e           | \ |             | \_ |       |              | utstanding |
| xpectations | _ |             | C  |       |              | +          |
|             | \ |             | om |       |              |            |
|             | _ |             | me |       |              |            |
|             | M |             | nd |       |              |            |
|             | e |             | ab |       |              |            |
|             | e |             | le |       |              |            |
|             | t |             | +  |       |              |            |
|             | s |             |    |       |              |            |
|             | e |             |    |       |              |            |
|             | x |             |    |       |              |            |
|             | p |             |    |       |              |            |
|             | e |             |    |       |              |            |
|             | c |             |    |       |              |            |
|             | t |             |    |       |              |            |
|             | a |             |    |       |              |            |
|             | t |             |    |       |              |            |
|             | i |             |    |       |              |            |
|             | o |             |    |       |              |            |
|             | n |             |    |       |              |            |
|             | s |             |    |       |              |            |
|             | + |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| \_\_\_      | \ |             | \_ |       | \_\_\_       |            |
| Meets       | _ |             | \_ |       | Outstanding  |            |
| e           | \ |             | \_ |       | -            |            |
| xpectations | _ |             | E  |       |              |            |
| -           | \ |             | xc |       |              |            |
|             | _ |             | el |       |              |            |
|             | C |             | le |       |              |            |
|             | o |             | nt |       |              |            |
|             | m |             | -  |       |              |            |
|             | m |             |    |       |              |            |
|             | e |             |    |       |              |            |
|             | n |             |    |       |              |            |
|             | d |             |    |       |              |            |
|             | a |             |    |       |              |            |
|             | b |             |    |       |              |            |
|             | l |             |    |       |              |            |
|             | e |             |    |       |              |            |
|             | - |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| \_\_\_      | \ |             | \_ |       | \_\_\_       |            |
| Meets       | _ |             | \_ |       | Outstanding  |            |
| e           | \ |             | \_ |       |              |            |
| xpectations | _ |             | E  |       |              |            |
|             | \ |             | xc |       |              |            |
|             | _ |             | el |       |              |            |
|             | C |             | le |       |              |            |
|             | o |             | nt |       |              |            |
|             | m |             |    |       |              |            |
|             | m |             |    |       |              |            |
|             | e |             |    |       |              |            |
|             | n |             |    |       |              |            |
|             | d |             |    |       |              |            |
|             | a |             |    |       |              |            |
|             | b |             |    |       |              |            |
|             | l |             |    |       |              |            |
|             | e |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| **S         |   |             |    |       |              |            |
| econd-level |   |             |    |       |              |            |
| Managerial  |   |             |    |       |              |            |
| Approval of |   |             |    |       |              |            |
| Performance |   |             |    |       |              |            |
| Review      |   |             |    |       |              |            |
| Document**  |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| I have      |   |             |    |       |              |            |
| reviewed    |   |             |    |       |              |            |
| and         |   |             |    |       |              |            |
| approved    |   |             |    |       |              |            |
| the         |   |             |    |       |              |            |
| performance |   |             |    |       |              |            |
| review      |   |             |    |       |              |            |
| document    |   |             |    |       |              |            |
| and overall |   |             |    |       |              |            |
| rating.     |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| Signature   |   |             |    |       |              |            |
| \_\_\_\_\   |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| Date        |   |             |    |       |              |            |
| \_\_\_\_    |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| (Manager of |   |             |    |       |              |            |
| reviewer)   |   |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| **Reviewer  |   |             |    |       |              |            |
| Ackn        |   |             |    |       |              |            |
| owledgement |   |             |    |       |              |            |
| of          |   |             |    |       |              |            |
| Performance |   |             |    |       |              |            |
| Review      |   |             |    |       |              |            |
| Document**  |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| I have      |   |             |    |       |              |            |
| discussed   |   |             |    |       |              |            |
| the         |   |             |    |       |              |            |
| performance |   |             |    |       |              |            |
| review      |   |             |    |       |              |            |
| document    |   |             |    |       |              |            |
| with the    |   |             |    |       |              |            |
| employee    |   |             |    |       |              |            |
| and advised |   |             |    |       |              |            |
| the         |   |             |    |       |              |            |
| employee of |   |             |    |       |              |            |
| his/her     |   |             |    |       |              |            |
| overall     |   |             |    |       |              |            |
| rating.     |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| Reviewer    |   |             |    |       |              |            |
| Signature   |   |             |    |       |              |            |
| \_\         |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| Date        |   |             |    |       |              |            |
| \_\_        |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| (Person who |   |             |    |       |              |            |
| prepared    |   |             |    |       |              |            |
| the review) |   |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| **Employee  |   |             |    |       |              |            |
| Ackn        |   |             |    |       |              |            |
| owledgement |   |             |    |       |              |            |
| of          |   |             |    |       |              |            |
| Performance |   |             |    |       |              |            |
| Review      |   |             |    |       |              |            |
| D           |   |             |    |       |              |            |
| iscussion** |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| My          |   |             |    |       |              |            |
| supervi     |   |             |    |       |              |            |
| sor/manager |   |             |    |       |              |            |
| has         |   |             |    |       |              |            |
| reviewed    |   |             |    |       |              |            |
| and         |   |             |    |       |              |            |
| discussed   |   |             |    |       |              |            |
| the         |   |             |    |       |              |            |
| performance |   |             |    |       |              |            |
| review      |   |             |    |       |              |            |
| document    |   |             |    |       |              |            |
| with me. My |   |             |    |       |              |            |
| signature   |   |             |    |       |              |            |
| means that  |   |             |    |       |              |            |
| I have been |   |             |    |       |              |            |
| advised of  |   |             |    |       |              |            |
| my          |   |             |    |       |              |            |
| performance |   |             |    |       |              |            |
| status and  |   |             |    |       |              |            |
| does not    |   |             |    |       |              |            |
| necessarily |   |             |    |       |              |            |
| imply that  |   |             |    |       |              |            |
| I agree     |   |             |    |       |              |            |
| with it.    |   |             |    |       |              |            |
|             |   |             |    |       |              |            |
| Employee    |   |             |    |       |              |            |
| Signature   |   |             |    |       |              |            |
| \_\         |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| Date        |   |             |    |       |              |            |
| \_\_\_      |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
| \_\_\_\_\_\ |   |             |    |       |              |            |
| _\_\_\_\_\_ |   |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| **Employee  |   |             |    |       |              |            |
| Comments    |   |             |    |       |              |            |
| (           |   |             |    |       |              |            |
| Optional)** |   |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+
| **Mentor    |   |             |    |       |              |            |
| Comments    |   |             |    |       |              |            |
| (           |   |             |    |       |              |            |
| Optional)** |   |             |    |       |              |            |
+-------------+---+-------------+----+-------+--------------+------------+