AL KHAFJI NATIONAL HOSPITAL

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Annual Performance Appraisal

Name: Employee I.D:

Position: Date of Appraisal:
Department:

Directions: Using the scale in each item, please tick the box that best reflects your rating of your own
performance/performance of your staff during the past year. Thank you for your contribution to this very important
process.

VOLUME OF WORK SITUATIONAL

How does the amount Output is Insufficient – EVIDENCE
Exceptionally high Output is usually Done the
of work done compare occasionally improvement
output above average required
with the job unsatisfactory needed
requirements?
Supervisor’s Assessment     
Self-Assessment     
JOB KNOWLEDGE Exceptionally Good knowledge Lack of job Inadequate
Does the employee have thorough knowledge of own job and Done the knowledge knowledge of own
the knowledge to do the of own and related related work required sometimes work
job properly? work aspect hinders progress
Supervisor’s Assessment     
Self-Assessment     
Highly motivated A good attitude to Sometimes has to
SAFETY AWARENESS Done the Disregards basic
towards safety. Always safety and be reminded of
Consider in regard to safe required safety precautions
insists on safe working encourages others safety precautions
working practices
practices likewise at work
Supervisor’s Assessment     
Self-Assessment     
DEPENDABILITY Requires more
Always thoroughly Little supervision Done the Requires constant
How well does the frequent checks
employee follow reliable required required supervision
than normal
procedures?
Supervisor’s Assessment     
Self-Assessment     
TEAMWORK Works extremely well
Usually gets along
How well does the with others and
Co-operative and Done the reasonably well Uncooperative,
employee work with responds
others to accomplish the flexible required but sometimes resists change
enthusiastically to
goals of the job and work unhelpful
new challenges
group?
Supervisor’s Assessment     
Self-Assessment     
ATTENDANCE &
Attendance levels Absence and/or
PUNCTUALITY Exceptionally punctual. Done the Frequently late
are acceptable and lateness levels are
What is the employee’s Rarely absent required and/or absent
pattern of absence and is sometimes late higher than average
punctuality?
Supervisor’s Assessment     
Self-Assessment     
WORK PLANNING Needs to
Displays excellent Organizes work Done the improve some Does not plan
Consider employee’s success planning ability well required aspects of work effectively
in planning own work planning
Supervisor’s Assessment     
Self-Assessment     
COMMUNICATION Exceptionally Some difficulties Does not
How effective is the effective in all Usually a good Done the
with written & communicate
employee at verbal and written and verbal communicator required
verbal and effectively
written communication? communication listening
Supervisor’s Assessment     
Self-Assessment     

Issue Date: 01/04/2017 Issue No. /Revision No. : 01/01 Document Code: HR/F.20/01 Page 1 of 2
 Unsatisfactory
More than Less than
Well ahead of below the
satisfactory Done the satisfactory needs
OVERALL MARKING standard standard
slightly above job required slight
performance reasonably
requirements improvement
expected
Supervisor’s Assessment     
Self-Assessment     
CORE VALUES: Occasionally Insufficient –
Exceptional Above Average Average improvement
Professionalism with Caring Unsatisfactory
needed
Supervisor’s Assessment     
Self-Assessment     
CORE VALUES: Occasionally Insufficient –
Exceptional Above Average Average
Ownership with Unsatisfactory improvement
Accountability needed
Supervisor’s Assessment     
Self-Assessment     
CORE VALUES: Occasionally Insufficient –
Exceptional Above Average Average improvement
Building Trust Unsatisfactory
needed
Supervisor’s Assessment     
Self-Assessment     
CORE VALUES: Occasionally Insufficient –
Exceptional Above Average Average improvement
Improving Together Unsatisfactory
needed
Supervisor’s Assessment     
Self-Assessment     
CORE VALUES: Occasionally Insufficient –
Exceptional Above Average Average improvement
Knowledge Transfer Unsatisfactory
needed
Supervisor’s Assessment     
Self-Assessment     
CORE VALUES: Occasionally Insufficient –
Exceptional Above Average Average improvement
Creativity Unsatisfactory
needed
Supervisor’s Assessment     
Self-Assessment     

General Comment of the Supervisor/Manager:

What is your departmental objective?

What is the objective you set for this employee to achieve your departmental objective?

What is the development you made for your employees, please specify per employee?

Recommended Trainings for the Employee.

General Comment from the Employee.

What is the objective set by your manager?

What is your career aspirations?

What do you do to develop yourself?

What do you need from KNH to develop you?

Appraiser’s Signature: Date:

Appraisee’ s Signature: Date:

Issue Date: 01/04/2017 Issue No. /Revision No. : 01/01 Document Code: HR/F.20/01 Page 1 of 2