PRIVATE

BROOKHAVEN NATIONAL LABORATORY

Scientific Staff Performance Appraisal

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  Name:                                Department:        Date:        

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  **Signature:**                                        **Performance      FY  
                                                        Period:**          

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Please complete Part I and submit it to your reviewer. The information
you provide in Part I is needed for effective performance reviews. Enter
"N/A" in those sections that do not apply. Use additional pages if
necessary. For complete instructions, refer to SBMS [Performance
Appraisal Process for Scientific Staff]{.underline}.

**PART I -- SCIENTIFIC RECORD**

**Research Accomplishments:** List Awards, Honors, Fellowships, and
research activities and accomplishments for the past performance period.

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**Facility Development and Support Activities:** List accomplishments
that support the mission of the facility.

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**Publications:** List publications and reports submitted and/or
published in refereed or non-refereed journals during the past year.
Please remember to include those submitted by your collaborators on
which your name appears.

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**Invited Scientific Talks:** List meeting information - *sponsoring
organization, type of meeting or symposia, location, dates* . . .
Include invitations that were declined. In addition, list papers
presented at these meetings or reference them if they are mentioned in
the Publications section above.

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**Part I - Scientific Record (Continued)**

**Posters and Other Presentations:** List meeting information and
identify poster presentations -- *Title, authors, poster presented at .*
. . In case of several authors, please list person making the
presentation as first author.

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**Departmental Colloquia and Other Professional Activities and Honors:**
List BNL and other committees, panels, teaching, patents, etc.

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**Research Grants and Proposals:** Give the title, agency, amount,
period, and grant number for funded projects. Indicate any which are
pending or have not been funded.

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**Employee Self-Appraisal:** Please add any comments that would be
helpful in terms of your Performance Appraisal.

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#  PART II -- REVIEWER'S APPRAISAL 

**SCIENTIFIC PERFORMANCE:**

*Provide a narrative below. In your appraisal, consider performance on
the employee's research activities, and the accomplishments documented
in Part I above. The spaces will expand as needed.*

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**General Performance Factors**:

*In this section, comment on the relevant general performance factors.
The spaces will expand as needed.*

**Environmental, Safety, Health and Quality** - *knowing and adhering to
ESH&Q requirements, maintaining a safe workplace, being current with all
BNL training requirements, and having a positive attitude towards
safety.*

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**Human Resources/Diversity** - *interpersonal skills, respect for
others, support for Laboratory Equal Employment Opportunity and
Diversity goals.*

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Supervisory Skills (if applicable) - *leadership, work distribution,
motivation, communication, and employee development.*

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| **OVERALL APPRAISAL:**                                                |
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| *For the Overall Appraisal, consider all relevant information.        |
| Provide a brief narrative. Assign the Summary Performance Level       |
| rating in the space provided below.*                                  |
|                                                                       |
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# SUMMARY Performance Level: [  ]{.underline}

***DP\*** (Distinguished Performer) = Consistently and markedly exceeds
Laboratory standards for scientific excellence. Employee's achievements
are seldom equaled by other scientific staff who have similar work
assignments.*

***CP** (Commendable Performer) = Clearly meets Laboratory standards for
scientific excellence. Most experienced scientists at BNL are expected
to achieve this performance level.*

***AP\*** (Adequate Performer) = Achieves many of the expected standards
for scientific excellence. Some key aspects are below expectations and
improvement is needed.*

***UP\*** (Unsatisfactory Performer) = One or more key areas of
performance do not meet minimum standards for scientific excellence.
Improvement is clearly required.*

*\* Narrative required for this rating.*

### PART III -- R2A2 RESPONSIBILITIES

If R2A2 has been updated, attach updated R2A2 to the form. If there have
been no changes to R2A2 responsibilities during this past performance
period, please indicate the date of the R2A2 that remains in effect in
the space below.

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### PART IV -- EMPLOYEE COMMENts: Optional

Employee adds any remarks to the form before signing it. If they
disagree with the appraisal, they may provide comment.

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### PART IV -- SIGNATURES

*The reviewer, senior reviewer, and the employee must sign and date the
form.*

**Reviewer's Signature**: Date:

**Senior Reviewer's Signature**: Date:

\***Employee\'s Signature**: Date:

\*Your signature indicates neither agreement nor disagreement with the
appraisal, but it does indicate that you have read the manager's
appraisal and it has been discussed with you.