<table>
<colgroup>
<col style="width: 25%" />
<col style="width: 13%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 9%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="3"><blockquote>
<p><strong>INDIVIDUAL PERFORMANCE RATING</strong></p>
</blockquote></td>
<td colspan="9"><blockquote>
<p>INSTRUCTIONS: The immediate supervisor will prepare this form for a
subordinate<br />
person. Rating will be reviewed with the individual who will sign and
date the form.<br />
The completed rating will be given to the Planning Section Chief before
the rater<br />
leaves the incident.</p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>1. NAME</p>
</blockquote></td>
<td colspan="9"><blockquote>
<p>2. INCIDENT NAME AND NUMBER START DATE OF INCIDENT</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="9"><blockquote>
<p>           </p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>3. HOME UNIT ADDRESS</p>
</blockquote></td>
<td colspan="9"><blockquote>
<p>4. INCIDENT AGENCY AND ADDRESS</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="9"><blockquote>
<p>     </p>
</blockquote></td>
</tr>
<tr class="even">
<td><blockquote>
<p>5. POSITION HELD ON INCIDENT</p>
</blockquote></td>
<td colspan="3"><blockquote>
<p>6. TRAINEE POSITION</p>
</blockquote></td>
<td colspan="4"><blockquote>
<p>7. INCIDENT COMPLEXITY</p>
</blockquote></td>
<td colspan="4"><blockquote>
<p>8. DATE OF ASSIGNMENT</p>
</blockquote></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="3"><blockquote>
<p> YES NO</p>
</blockquote></td>
<td colspan="4"> I II III</td>
<td colspan="4"><blockquote>
<p>FROM:       TO:      </p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="8"><blockquote>
<p>PERFORMANCE LEVEL</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="4"><blockquote>
<p>9. List the main duties from the Position Checklist, on which
the<br />
position will be rated.</p>
<p>Enter X under the appropriate column indicating the individuals
level<br />
of performance for each duty listed.</p>
</blockquote></td>
<td colspan="2">Did not apply<br />
on this incident</td>
<td>Unacceptable</td>
<td colspan="2">Need to Improve</td>
<td colspan="2">Fully Successful</td>
<td>Exceeds<br />
Successful</td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="2">     </td>
<td>     </td>
<td colspan="2">     </td>
<td colspan="2">     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="12"><p>10. REMARKS</p>
<blockquote>
<p>     </p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="9"><blockquote>
<p>11. THIS RATING HAS BEEN DISCUSSED WITH ME (Signature of individual
being rated.)</p>
</blockquote></td>
<td colspan="3">12. DATE<br />
     </td>
</tr>
<tr class="odd">
<td colspan="2"><blockquote>
<p>13. RATED BY (Signature)</p>
</blockquote></td>
<td colspan="3">14. HOME UNIT<br />
     </td>
<td colspan="5">15. POSITION HELD ON THIS INCIDENT<br />
     </td>
<td colspan="2">16. DATE<br />
     </td>
</tr>
</tbody>
</table>

> \*U.S. GPO: 1991-594-696/40141 **NFES 2074 ICS FORM 226 (6/89)**