1. Print a form for each one of your employees who is a supervisor or manager.
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1 These instructions are to be used to complete the 90-Day Manager/Supervisor Performance Review Form utilized by University Physicians and the Medical Center. 1. Print a form for each one of your employees who is a supervisor or manager. 2. Complete all information requested at the top of the form beginning with the section titled Employee Name and ending with the section titled Employee FLSA Status. 3. Please read the Instructions section of the form and then complete sections In the Summary section on page 4, check the box next to the rating that best describes the employee s overall performance. 5. Complete the sections pertaining to areas in which the employee s performance is best and what the employee can do to improve performance. These sections are immediately below the Summary section on page Discuss the evaluation with the employee and have him/her sign the form, enter their employee number, and enter the date. 7. Give the employee an opportunity to include comments in the Employee Remarks section on page 4 of the form. This is optional. 8. The supervisor, the evaluator (if different from supervisor) and the department head should sign the form, enter his/her employee number, and enter the date in the appropriate section. 9. Make two copies of the form, one for the department and one for the employee. 10. Send the original form via campus mail to Molly Brasfield, Department of Human Resources.
2 University of Mississippi Medical Center Supervisor/Manager Performance Review Form Employee Name: Employee Number: Employee Position Title: Employee Job Code: Employee Grade: Department Name: Today s : Manager s Name: Manager s Title: Manager s Employee Number: Check on of the following: Annual Evaluation Probationary Evaluation Special Evaluation Employee FLSA Status: Salaried Exempt Hourly Non-exempt Instructions: Beside each trait or characteristic listed below is a statement describing satisfactory performance. Based upon the definitions immediately following, check the rating under each trait/characteristic that best describes the manager s/supervisor s actual performance, using the description for satisfactory performance as a benchmark. The ideal manager/supervisor. Consistently exceeds the department s expectation. Frequently exceeds the department s expectation. Meets the department s expectation. Infrequently meets the department s expectation. Fails to meet the department s expectation. 1. LEADERSHIP SKILLS Inspires and motivates to accomplish departmental objectives. 1
3 2. DELEGATION Effectively delegates the work load along with authority and responsibility. 3. PROBLEM SOLVING Obtains and evaluates facts and from consideration of all facts, comes to a sound, logical conclusion. 4. INITIATIVE Is aware of what must be accomplished in order to meet departmental objectives and is willing to act without being instructed. Independent; self starter. 5. DECISION MAKING Willing and able to arrive at a conclusion or a course of action. Doesn t rely on others to make decisions for him/her. 6. STABILITY Remains calm and takes appropriate action in crisis situations. 2
4 7. COOPERATION/RESPECTABILITY Gets along well with subordinates. Has earned their respect and confidence. 8. COMMUNICATION Effective in both written and verbal communication. Information and instructions are given in a clear, concise manner. 9. KNOWLEDGE Has a clear understanding of his/her job objectives, duties and responsibilities. 10. ATTITUDE Shows interest and enthusiasm for the job; i.e., maintains an acceptable attendance record, willingly accepts responsibility, accepts and adjusts to changes, supports Management even if not always in agreement, works in harmony with managers, co-workers and subordinates. 3
5 Summary Based on the individual ratings given, what overall rating would you assign this employee? EXCELLENT AVERAGE Describe those areas in which the employee s performance is best. What can this employee do to improve performance? Employee Remarks: (Areas in which you believe you do well; recognized areas for improvement; suggestion and criticism) Signatures: Employee s Signature and Employee Number (Signature indicates that performance review has been reviewed and discussed with employee.) Supervisor s Signature and Employee Number Evaluator s Signature and Employee Number (Complete if Evaluator is different from Supervisor) Department Head s Signature and Employee Number 4
University of Mississippi Medical Center Employee Performance Review Form. Employee Position Title: Employee Job Code: Employee Grade:
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