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Annual Performance Evaluation Form

Performance Assessment Period: From 01-07-2022 To 31-08-2022

Employee Name : Pawlina Mardi PIN : 50106

Name of the first

Designation : : Dr.Ashaduzzaman noor
Medical technologist Appraiser

Department/Project : CNCDN Title of the first Appraiser : Research medical officer

Name of the second

Date of joining : : Tulsi chandra
Appraiser
Contract ending Title of the second
: : Field coordinator
date Appraiser
Length of Service Total Length of Service
: :
with JPGSPH on the present position

In case of the scale of five (5)- please follow the below –

10= Outstanding Performer (Constantly exceeds position requirements)
8= Superior Performer (Constantly meets and occasionally exceeds position requirements)
6= Competent Performer (Meets the position requirements)
4= Requires Improvement (Occasionally does not meet minimum position requirement)
2= Unacceptable performer (Does not meet minimum position requirement)

Part I- Key Performance Indicator (KPI)

Achieve KPI
Supervisor’s comments

1. Recruitment of 1,000 study participants per 08 satisfactory

study cluster

2. Number and Quality of listing done by the 08 satisfactory

staff (cutoff is avg. listing per day)

3. Registration is done from listing schedule*/ 08 satisfactory

completeness of preparatory lab work

4. Completeness and quality of data collected 06 Upto mark

by the research assistants and biological
sample management by the medical
technologists
5. quality of participants counseling at field or 06 Upto mark
screening station

6. Follow the given randomized schedule/ 08 Satisfactory

maintain the inventory instruction properly

7. Take care of the device/ consumable items at 08 satisfactory

his/ her station

8. Work done outside the designated 10 Willingly do any task assigned by

work/station
supervisiors.
9. Participation in training/ meetings 06 satisfactory
10. Proactive participation during cluster packing, 08 Satisfactory
transfer, and new cluster setup
Total= 100 76

Total marks obtained (…..)

*Depends on the proportion between registration is done and number of participants in the given enumeration
list
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Rating Scale: Total 10 marks

In case of the scale of ten (10)- please follow the below –
10= Outstanding Performer (Constantly exceeds position requirements)
8= Superior Performer (Constantly meets and occasionally exceeds position requirements)
6= Competent Performer (Meets the position requirements)
4= Requires Improvement (Occasionally does not meet minimum position requirement)
2= Unacceptable performer (Does not meet minimum position requirement)
Part II- Skills & Key Competencies
PEOPLES SKILLS Marks Comments
Communication & interpersonal Effectiveness 06 Good
 Able to convey and receive written and verbal information clearly concisely and to the point.
 Good communication with a courteous and friendly manner.
 Respect others and be able to use diplomatic and tactful skills without issues.
Leadership 06 Improvement
 Competent / feel confident in fieldwork
 Motivate the team members needs
 Able to set realistic targets and achieve the targets within the allocated time
Responsiveness 08 satisfactory
 Respond actively and sensitively to the needs of internal and external associates.
PERSONAL QUALITIES
Commitment & Sense of Responsibility 08 Satisfactory
 Willing to take up responsibilities. Punctual for good attendance record.
 How sincere and dedicated to performing his/her job.
Independence & Creative Thinking 06 satisfactory
 Able to take effective action without being told and with minimum supervision
Time Management 08 Good at time
 Usages own and other’s time effectively to agree on the desired outcomes, accomplish,
goals and prioritizes to minimize conflicts management
Handling Stress 06 SATISFACTORY
 Remain calm and focused under stress & generate outcomes without deterioration in quality
TASK SKILLS
Teamwork
 Work effectively with groups to achieve common goals & willing to support colleagues 06 SATISFACTORY
 Able to maintain and promote a harmonious relationship among colleagues
Negotiation Skills
 Prepares for negotiating well, relates honestly to others, identifies and acknowledges
signals, encourages movement from a fixed position, gives clear signals and reaches
06 SATISFACTORY
lasting agreement without making unplanned concessions
Planning & Organizing
 Understand objectives and set priorities
 Able to organize working effectively and anticipate potential problems
06 SATISFACTORY
 Eager to Know the details of any matter to optimize the result
Total 66
Total marks obtained (out of 10)
Obtained Marks
Total Marks obtained (out Percentage of
Key Performance Indicator Skills & Key Competencies
of 200) mark obtained
76 66 142 71%

Strength of the Employee

Strength Details
1 Sincere,Proactive
2 Hardworker
3 Very polite with participants

Development Needs of the Employee

Development Details
1 Needs to improve communication skill
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2 Teamwork relationship needs to be enhanced.

3 Computer skill

Acknowledgement by the Employee being appraised on the above performance

She is very energetic & prompt to deliver any kind of task assigned by the supervisiors. I strongly recommend
to extend her contract period.

First Appraiser’s Recommendation with signature (Not to be seen by the Appraisee)

Second Appraiser’s Recommendation with signature

Salary and other benefits (for HR department use only)

Components Previous Year Present Proposed Other Recommendation
Salary
Increment
□ Only increment
□ Only extension
Contract Renewal □ Termination
□ Re-designation
Date of Last To be
Promotion Promoted as

Finance Clearance Dean’s approval

Project Name: The increased amount Budget coverage up to:
is within budget:

NCD-Surveillance-Phase II

Signature: