Self-Appraisal Form

Review Period (20 -20 )

Name:	Department:

Title:	Supervisor:

Grade:	Supervisor’s Title:

DOH in Position: Date:

To assist with the assessment of your performance, you are required to complete and submit this Self-Appraisal Form to your supervisor by mid-March. It ensures that your supervisor will be aware of your accomplishments, challenges and the obstacles you faced this year when evaluating your performance for the current review period. This Self-Appraisal also allows you to identify the professional training and development opportunities you would like to take advantage of in the upcoming review period.
Part A - Accomplishments: Please provide a brief description of your accomplishments for the current review period. You should include critical assignments you successfully completed, trainings you attended, goals you attained and any responsibilities you assumed outside of the scope of your position description. Please also include any positive recognition you received from your supervisor, colleagues and/or customers.

Click Here to Enter Accomplishments

Part B - Challenges: Please provide a brief description of the challenges you encountered during the current review period. You should also include critical assignments you have not fully completed and/or goals you have not achieved. Please include any resources that would have helped you avoid these challenges.

Click Here to Enter Challenges

Part C –Training and Development Opportunities: Please list any professional training and development opportunities you would like to complete in the upcoming review period.

Click Here to Enter Training Opportunities

I certify this Self-Appraisal has been submitted to my supervisor.

_______________________________________________	________________________

Staff Member Signature	Date