1
Staff Info
2
Objectives
3
Performance
4
Potential
5
Results
Staff Information
to
Achievement on Targets / Objectives
Max 50 marks (5 marks per KPI, 10 KPIs)

List all agreed targets or KPIs for the period. Rate achievement for each on a scale of 1–10 (1 = lowest, 10 = highest).

# Target / Objective Indicated Action / Notes Supervisor's Rating
Comment by Staff
Reaction by Supervisor
Critical Performance Factors
Max 50 marks (5 per factor)

Rate each factor from 1 (Below Expectation) to 5 (Exceptional).

1 — Below Expectation 2 — Needs Improvement 3 — Barely Meets Expectation 4 — Exceeds Expectation 5 — Exceptional
Potential Assessment
i.
ii.
iii.
iv.
Final Score & Summary
Performance Results
Section A
out of 50
Section B
out of 50
Total
out of 100
Performance Grade
—%
Section A — Objectives & Scores
Section B — Critical Performance Factors
Staff Summary
Signatures
Employee Signature
Name: ____________________________
Date: ____________________________
Supervisor Signature
Name: ____________________________
Date: ____________________________
HR Representative
Name: ____________________________
Date: ____________________________
Director / Senior Management
Name: ____________________________
Date: ____________________________