APPENDIX G MONTGOMERY COUNTY, MARYLAND PERFORMANCE PLANNING AND EVALUATION FORM

 

EMPLOYEE INFORMATION

 

Employee Name: Social Security Number: Job Title:	Department: Division/Team:
Supervisor Name(s):	Reviewing Official Name:
Type of Evaluation: _____Annual _____Interim	Review Period: From ____/____/____(date) To ____/____/____(date)

 

DOCUMENTATION SIGNATURES

Activity to be documented	Date	Signature
Performance Plan Finalized (Employee)
Performance Plan Finalized (Supervisor)
Mid Year Progress Discussion (Employee)
Mid Year Progress Discussion (Supervisor)
Evaluation Reviewed by Employee* *Does not indicate agreement
Evaluation Finalized by Supervisor
Evaluation Reviewed by Reviewing official

 

OVERALL RATING

_____ Exceptional Performance            _____ Successful Performance

_____ Highly Successful Performance         _____ Does Not Meet Expectations

This form is for employees who are not in a bargaining unit position or an MLS position. Note for automated versions of this form: This form is in a Word Perfect tables format. Each row will expand as you type into it. Hit tab key when at the bottom of the row to create additional rows. All automated forms must be safeguarded or password protected from unauthorized viewing.

 

PERFORMANCE PLAN

PART 1: INDIVIDUAL OR TEAM SPECIFIC EXPECTATIONS

Plan Development: This section should list the performance expectations for this individual and/or team. Clearly indicate which expectations will receive team ratings (as applicable). If feedback from non-supervisors will be obtained, describe the source and approach to obtaining and utilizing this information (as applicable). Serious corrective performance improvement issues may be addressed in a separate work improvement plan.

Evaluation: Ratings should be based on the degree to which the employee/team achieved or met the performance expectation. Narrative Comments are required for all ratings.

#1

Narrative Comments for #1

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

#2:

Narrative Comments for #2

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

#3:

Narrative Comments for #3

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

 

#4:

Narrative Comments for #4

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

#5:

Narrative Comments for #5

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

PART 2: GENERAL EXPECTATIONS & COMPETENCIES

General expectations and competencies are generic in nature and may apply to a cross section of positions and functions

Plan: Each general expectation or competency listed below must include a description and/or behavioral examples of the expected performance (below or in an attachment). Evaluation: Team ratings do not apply to general expectations or competencies

#1:

Narrative Comments for #1

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

#2:

Narrative Comments for #2

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

#3:

Narrative Comments for #3

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

#4

Narrative Comments for #4

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

#5

Narrative Comments for #5

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

#6

Narrative Comments for #6

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

#7

Narrative Comments for # 7

Rating: ____ Exceptional ____ Highly Successful _____ Successful ___ Does Not Meet Expectations

(add more boxes as needed)

 

 

CAREER DEVELOPMENT (REQUIRED)

Goal or Competency to be developed:

Year End Accomplishment Summary:

 

PROGRESS DISCUSSION NOTES

Supervisor:

Employee:

 

COMMENTS

Supervisor:

Employee: