Performance Appraisal Template
Performance Appraisal Template
Performance Appraisal Template
CONFIDENTIAL
Department Chief Being Evaluated: _______________________________________
Department:________________________________
Based on your interactions with this Department Chief, please indicate your assessment in the
following areas: (please complete both sides of this form).
1. INTRODUCTIONS
The 360 performance evaluation tool provides many with an opportunity to give valuable
feedback regarding the performance and leadership abilities. In order to provide meaningful
information, you must be honest and direct with your ratings and your comments. All surveys
are anonymous and cannot be traced to the evaluator unless the written comments contain
details to enable identification.
Chief of Staff
The following questions will explain your professional relationship with the Department Chief
2.1 My relationship with this Department Chief is:
Daily Several times a week Once a week 2-3 times per month Once a month or
less
3. LEADERSHIP
N/A or
unable to
assess
N/A or
unable to
assess
4. BUILDING
RELATIONSHIPS AND
PARTNERSHIPS
5. CHANGE MANAGEMENT
SKILLS
N/A or
unable to
assess
6. COMMUNICATION
SKILLS
N/A or
unable to
assess
N/A or
unable to
assess
N/A or
unable to
assess
6.1 Is effective in
communicating plans,
information and perspective in
spoken form.
6.2 Is effective in
communicating plans,
information and perspective in
written form.
6.3 Is an effective listener.
Comments or Opportunities for Improvement:
7. COMMUNICATION
SKILLS
7.1 Makes positive comments
and provides helpful
suggestions regarding the
development of others.
to learn.
7.3 Gives feedback that is
honest, specific and balanced
for developmental purposes.
7.4 Provides ongoing feedback
in behavioural rather than
personal terms.
Comments or Opportunities for Improvement:
8. PERSONAL CREDIBILITY
N/A or
unable to
assess
N/A or
unable to
assess
9. CONFLICT RESOLUTION
N/A or
unable to
assess
N/A or
unable to
assess
12. ACADEMIC
EXPECTATIONS
N/A or
unable to
assess
Please provide comments or examples illustrating the Department Chief NOT MEETING
expectations:
N/A or
unable to
assess
13.1 Please provide any additional comments to assist the Chief to improve personal or
8
departmental performance.
N/A or
1
2
3
4
5
unable to
14. THANK YOU
assess
Thank for taking the time to complete this survey. Unless you have provided potentially
identifying comments or clues in your written responses, these surveys are completely
anonymous.
These results in the aggregate, will be used in the annual performance review of the
Department Chief.