ANNUAL PERFORMANCE EVALUATION FORM SECONDARY CHIEF EXECUTIVE OFFICER
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1 ANNUAL PERFORMANCE EVALUATION FORM SECONDARY CHIEF EXECUTIVE OFFICER Name of Incumbent: Evaluation Period: Date: SECTION Section 1: Annual Goals Section 2: Assessment of Capabilities Section 3: Performance Summary and Sign-Off DESCRIPTION The organization s annual goals, as approved by the Board of Directors at the end of the preceding fiscal year, as well as other goals identified by the Board or the CEO Performance Evaluation Committee, are entered in this section. (These goals form the basis of the CEO Performance Management Plan.) The CEO Performance Evaluation Committee reviews these goals at each quarterly review to ensure that they remain current with the changing environment. During the mid-year review, the CEO meets with the CEO Performance Evaluation Committee to discuss progress. At year-end, the CEO Performance Evaluation Committee evaluates the CEO s performance ratings for each goal. The CEO Performance Evaluation Committee evaluates the performance of the CEO based on the 360-degree capability assessment, as well as other relevant feedback. The CEO Performance Evaluation Committee and the CEO identify areas for development and agree on a development plan. At the mid-year and year-end reviews, the CEO and the CEO Performance Evaluation Committee meet to discuss progress. This section is used to summarize the CEO s overall performance against expectations for the fiscal year. The CEO and the Board Chair sign off on the year-end performance review. Form II-5-ii(b) - CEO Performance Evaluation Form Secondary 1 APPROVED September 12, 2013
2 OVERVIEW OF THE RATING SCALE Use the following rating scale to rate the CEO s performance relative to expectations at year-end for Section 2: Assessment of Capabilities. RATING SCALE Exceeds Meets Partially Meets Does Not Meet Unable to Evaluate DESCRIPTION Performance/outcomes considerably surpass performance expectations on all key measures. Performance/outcomes consistently meet established expectations, and may exceed expectations in some aspects of performance. Performance/outcomes meet some, but not all, expectations. Performance is not at the fully acceptable level to achieve desired results, and may require further improvement or development. Performance/outcomes consistently do not meet expectations. Performance is at a level below what is necessary to achieve the desired results. Serious improvement is needed and a corrective action plan will be discussed. Insufficient information to evaluate the incumbent. Form II-5-ii(b) - CEO Performance Evaluation Form Secondary 2 APPROVED September 12, 2013
3 1. ANNUAL GOALS Prior to the end of the previous fiscal year, the Board of Directors approves the organization s goals in alignment with the annual strategic plan. Additional goals may be identified by the Board and the CEO Performance Evaluation Committee. The mid-year performance review includes a review of progress toward achieving these goals. The goals and related indicators are reviewed by the CEO Performance Evaluation Committee at each quarterly review to ensure that they remain current with the changing environment. Please refer to the CEO Performance Management Plan. Form II-5-ii(b) - CEO Performance Evaluation Form Secondary 3 APPROVED September 12, 2013
4 2. ASSESSMENT OF CAPABILITIES The CEO Performance Evaluation Committee evaluates the performance of the CEO based on the 360-degree capability assessment, as well as other relevant feedback. The CEO Performance Evaluation Committee and the CEO identify areas for development and agree on a development plan. At the mid-year and year-end reviews, the CEO and the CEO Performance Evaluation Committee meet to discuss progress. Capability Comments Year-End Review Exceeds Meets Partially Meets Does Not Meet Unable to evaluate DOMAIN: LEADS SELF DOMAIN: ENGAGES OTHERS DOMAIN: ACHIEVES RESULTS Form II-5-ii(b) - CEO Performance Evaluation Form Secondary 4 APPROVED September 12, 2013
5 Capability Comments Year-End Review Exceeds Meets Partially Meets Does Not Meet Unable to evaluate DOMAIN: DEVELOPS COALITIONS Form II-5-ii(b) - CEO Performance Evaluation Form Secondary 5 APPROVED September 12, 2013
6 Capability Comments Year-End Review Exceeds Meets Partially Meets Does Not Meet Unable to evaluate DOMAIN: SYSTEMS TRANSFORMATION Form II-5-ii(b) - CEO Performance Evaluation Form Secondary 6 APPROVED September 12, 2013
7 2. ASSESSMENT OF CAPABILITIES, CONTINUED Part 2 (a) - Review of Prior Year Development Plan Review outcomes from prior year development plan. Areas for Focus/ Development Planning Development Actions Timing Year-End Review Form II-5-ii(b) - CEO Performance Evaluation Form Secondary 7 APPROVED September 12, 2013
8 Part 2 (b) - Future Year Development Plan Identify areas of focus for development, including actions and a timeframe for completion. Refer to the results of the 360-degree capability assessment and other information sources to identify areas for development. Areas for Focus/ Development Planning Development Actions Timing Comments Form II-5-ii(b) - CEO Performance Evaluation Form Secondary 8 APPROVED September 12, 2013
9 3. PERFORMANCE SUMMARY AND SIGN-OFF Complete the following at the end of the performance cycle. Overall Rating: Annual Goals: Capabilities: Overall Rating Insert pay-out of performance management plan. Number of capabilities at or above target level: Exceeds Meets Partially Meets Does Not Meet CEO Comments: Board Chair Comments: CEO Signature: Date: Board Chair Signature: Date: Form II-5-ii(b) - CEO Performance Evaluation Form Secondary 9 APPROVED September 12, 2013
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