Performance Appraisal Form

Review Period (20 – 20 )

Name:	Department:
Title:	Supervisor:
Grade:	Supervisor’s Title:
DOH in Position: Date:

Section I: Performance Assessment

Part A: Core Competencies

The 5 core competencies listed below are vital to the success of all staff members at Brown. Please rate the staff member’s performance with respect to each of the core competencies - you should consult the University’s Performance Management Manual for further information. Please note that comments in this section are required for ratings of Consistently Exceeds, Does Not Consistently Meet or Does Not Meet Expectations.

Accountability Comments Expectations

Shows initiative; takes ownership of all responsibilities Seeks input and acts upon feedback Enhances personal knowledge, skills and abilities Follows through on responsibilities and tasks in an effective manner Is reliable and responsible	Select From Drop Down
Collaboration Comments Expectations

Serves as a positive team member and/or colleague Treats co-workers with respect, honesty and fairness Establishes productive working relationships Is flexible and adapts to changing priorities Resolves conflicts effectively	Select From Drop Down
Communication Comments Expectations

Communicates verbally and in writing at a level appropriate for his/her position Follows instructions and shares information appropriately Engages in meaningful, two-way conversations Speaks effectively, understands others, listens attentively and clarifies information when necessary	Select From Drop Down
Institutional Values Comments Expectations

Projects a positive image of Brown Embraces the University’s commitment to maintain a diverse and inclusive workplace Adheres to University policies and procedures Demonstrates commitment to the Strategic Plan, department goals and/or mission.	Select From Drop Down
Service Comments Expectations

Is accessible, offers assistance and support Responds in a timely and helpful manner Strives to provide exceptional service Demonstrates positive behavior and demeanor Promotes cooperation, collaboration and flexibility with contacts and colleagues	Select From Drop Down

Part B: Job Specific Competencies and Achievement of Goals*

Please list and rate the staff member’s performance regarding the top 3-5 critical responsibilities in his/her job description. When assessing the staff member’s performance, please consider the following factors: job knowledge; quality of work; judgment; and utilization of technology when available and appropriate. In the final row, please assess the staff member’s performance with respect to goals for the current review period. Please note that comments in this section are required for Consistently Exceeds, Does Not Consistently Meet or Does Not Meet Expectations.

Job Responsibility 1 Comments Expectations

Select From Drop Down
Job Responsibility 2 Comments Expectations

Select From Drop Down
Job Responsibility 3 Comments Expectations

Select From Drop Down
Job Responsibility 4 Comments Expectations

Select From Drop Down

Job Responsibility 5 Comments Expectations

Select From Drop Down

Goals Comments Expectations

When evaluating the staff member’s performance with respect to goals, please consider whether he/she: Identified meaningful goals Modified his/her goals to meet changing needs Pursued training and development opportunities Made sufficient progress toward the achievement of his/her goals	Select From Drop Down

*If you determine that the staff member’s job description does not accurately reflect his/her current duties and responsibilities, you should submit a revised draft to the Human Resources Department, Box 1879, for review.

Part C: Supervisory Competencies	Not Applicable ☒

The following competencies are vital to the success of all individuals who supervise staff and/or students. Please rate the staff member’s performance with respect to the supervisory competencies listed below. Please note that comments in this section are required for Consistently Exceeds, Does Not Consistently Meet or Does Not Meet Expectations.

Managing Performance Comments Expectations

Holds staff members accountable Provides timely, constructive and balanced feedback Completes performance appraisals honestly and fairly Works with staff members to prioritize and revise goals Maintains accurate records relative to performance Identifies training and development opportunities	Select From Drop Down
Leadership Comments Expectations

Provides positive leadership, support and direction Plans, controls and delegates effectively Motivates staff members to perform at the highest level Manages conflicts between staff members effectively Sets a positive example for his/her team Ensures compliance with University policies	Select From Drop Down

Section II: Overall Performance Appraisal Rating

Please provide an overall performance rating taking into consideration your assessment of the competencies in Section I, as well as the goals identified for the review period. You may only select one rating from the group below.

☐ Consistently Exceeds Expectations	☐ At Times Exceeds Expectations	☐ Consistently Meets Expectations	☐ Does Not Consistently Meet Expectations	☐ Does Not Meet Expectations

Overall Performance Appraisal Summary and Comments *

*Human Resources must review and approve overall ratings of Consistently Exceeds, Does Not Consistently Meet or Does Not Meet Expectations, prior to being issued. Appraisals with an overall rating of Does Not Consistently Meet or Does Not Meet Expectations, must be coupled with a notice of job expectations or a performance improvement plan.

Section III: training and Development Opportunities

Please identify any professional training and development opportunities you would like the staff member to complete during the next review period. Please consult www.brown.edu/learningpoint to view the internal training and development curriculum.

Training and Development Opportunities

Section IV: Staff Member’s Comments

Staff Member Comments

Signatures and verifications

I have reviewed this performance appraisal with my supervisor and was given an opportunity to provide comments in Section IV above.

Staff Member:	Date:

I have drafted and discussed this performance appraisal with the above named staff member. I have also reviewed the staff member’s position description to verify whether it accurately reflects his/her current job duties and responsibilities.

Supervisor:	Date:

I have read and approved this performance appraisal.

Next Level Supervisor:	Date: