Employee Performance Evaluation
Supervisor’s Evaluation

Employee:		Hire Date:		
Job Title:		
Supervisor:		
Date:		
Date of Last Review:		
Rating Scale:	E=Excellent   VG=Very Good   G=Good   F=Fair	
			  	     	     		
SKILLS		
E		
VG		
G		
F		
a.  Skills and knowledge necessary for job										
b.  Interest in and time spent improving skills and knowledge										
QUALITY OF PERFORMANCE										
Rate employee based on each of the duties listed on their job description numerically and attach a copy to this form.										
		
E		
VG		
G		
F		
1.  

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

										

RELIABILITY		
E		
VG		
G		
F		
a.  Attendance										
b.  Punctuality										
c.  Meeting deadlines										

WORK RELATIONSHIPS		
E		
VG		
G		
F		
a.  With other Staff Members										
b.  With Supervisor										
c.  Outside of Agency (if required)										
d.  Attitude										
e.  Cooperation										
MISCELLANEOUS		
E		
VG		
G		
F		
a.  Appearance										
b.  Overall Evaluation										

Comments:	

	
Training Plan:	

	

Job Description Reviewed and Updated?		 YES		 NO
(If Changes Made to Job Description, Attach a Revised Copy for Approval)

_________________________________________	                                                                      _______________________
Employee’s Signature	                                                                                                	 	     Date

__________________________________________	                                                                      _______________________
Supervisor’s Signature	                                                                                                 	    	     Date

Copy to Employee
Original to Personnel File

Employee Performance Evaluation
Self Evaluation

Employee:		Hire Date:		
Job Title:		
Supervisor:		
Date:		
Date of Last Review:		
Rating Scale:	E=Excellent   VG=Very Good   G=Good   F=Fair	
			  	     	     		
SKILLS		
E		
VG		
G		
F		
a.  Skills and knowledge necessary for job										
b.  Interest in and time spent improving skills and knowledge										
QUALITY OF PERFORMANCE										
Rate employee based on each of the duties listed on their job description numerically and attach a copy to this form.										
		
E		
VG		
G		
F		
1.  

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

										

RELIABILITY		
E		
VG		
G		
F		
a.  Attendance										
b.  Punctuality										
c.  Meeting deadlines										

WORK RELATIONSHIPS		
E		
VG		
G		
F		
a.  With other Staff Members										
b.  With Supervisor										
c.  Outside of Agency (if required)										
d.  Attitude										
e.  Cooperation										
MISCELLANEOUS		
E		
VG		
G		
F		
a.  Appearance										
b.  Overall Evaluation										

Comments:	

	
Training Plan:	

	

Job Description Reviewed and Updated?		 YES		 NO
(If Changes Made to Job Description, Attach a Revised Copy for Approval)

_________________________________________	                                                                      _______________________
Employee’s Signature	                                                                                                	 	     Date

__________________________________________	                                                                      _______________________
Supervisor’s Signature	                                                                                                 	    	     Date

Copy to Employee
Original to Personnel File

ANNUAL EMPLOYE EVALUATION
ACKNOWLEDGEMENTS

CONFIDENTIALITY STATEMENT

I __________________________________ an individual working with the Karuk Tribe, do hereby affirm that I have read and have been instructed on the Policy on Confidentiality.

I understand and agree that in the performance of my duties, as an employee of the Karuk Tribe that I must hold personal information in strict confidence and shall not share any personal information with unauthorized individuals who do not have a need to know.

I understand that any breach of confidentiality is a serious offense because it is an irreversible violation, and therefore may result in punitive action and even dismissal.

__________________________________________		_________________________
Employee’s Signature							Date

SUBSTANCE ABUSE CONTROL POLICY AND PROCEDURE

I hereby acknowledge that I have received a copy of the Karuk Tribe’s Substance Abuse Control Policy and Procedure.  I understand and agree that it is my responsibility to read and familiarize myself with it and abide by it.  I also understand that as a condition of employment I will be required to submit to testing under the policy and sign the Tribe’s authorization and medical information release forms.

__________________________________________		_________________________
Employee’s Signature							Date

HARASSMENT POLICY

I hereby acknowledge that I have received a copy of the Karuk Tribe’s Harassment Policy.  I understand and agree that it is my responsibility to read and familiarize myself with it and abide by it.

__________________________________________		_________________________
Employee’s Signature							Date