DEPARTMENT OF PEDIATRICS



DEPARTMENT OF PEDIATRICS

EMPLOYEE SELF-ASSESSMENT FORM

|Name (Print): |Review Period: |

|Job Title: |Division: |

Purpose: This form is designed to help the employee prepare for the annual performance review conversation with his/her supervisor. It will also be used to identify performance and career development activities that align with the employee’s interests. This form will be uploaded as an attachment to the employee’s online Staff Performance Review.

1. For the review period, list your most significant accomplishments and the way each accomplishment has impacted the Division (or Department).

2. What have you achieved towards fulfilling the work objectives (assignments/projects) that were established for the review period? How has the accomplishment of these work objectives contributed to your Division’s mission?

3. What have you achieved towards fulfilling the development goals that were established for the review period? How has the accomplishment of these goals impacted your performance?

4. What additional skills or knowledge would help you perform your present job responsibilities more effectively? How would you apply these skills or knowledge to your work?

5. What career development opportunities would you like to pursue that would help in your professional development and/or career growth?

6. What barriers prevent you from doing your best work? Include ideas on how to overcome these barriers.

7. List anything else that you would like to discuss during your annual performance review meeting with your supervisor.

I have reviewed and discussed this information with my supervisor.

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Employee’s Signature Supervisor’s Signature

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