Self Performance Evaluation

Employee Name:

Employee Email :

example@example.com

Supervisor's Name:

Supervisor's Email Address:*

Date:

Date

1. Knowledge/Skill Set: completion of required trainings, independent problem solving, utilizing resources

2. Quality Work: LOCSIs, PCISPs, Case Notes, Emails

3. Attitude: agency and team meetings, consumer meetings

4. Productivity and Efficiency: timely submission of work

5. Reliability and Dependability: email responsiveness, phone calls, and requests

6. Collaboration and Teamwork: global thinking

7. Communication: professional and responsiveness

8. Leadership: ability to motivate and facilitate

Evaluation of Skills

Rows	Needs Improvement	Below Average	Average	Above Average	Excellent
Knowledge/Skill Set
Quality of Work
Attitude
Productivity and Efficiency
Reliability and Dependability
Collaboration and Teamwork
Communication
Leadership

Growth Plan

Please list goals or ares in which you would like to gain additional skills in the next year.