fodkl vk;qDr (lw{e] y?

kq ,oa e/;e m|e) dk dk;kZy;

OFFICE OF THE DEVELOPMENT COMMISSIONER
(MICRO, SMALL & MEDIUM ENTERPRISES)
voj Js.kh fyfid@mPp Js.kh fyfid dh वािषक कायिनंपादन मूयांकन ूितवेदन/ Forms of
Annual Performance Assessment Report of Lower Division Clerk/Upper Division Clerk
CSSS
--------------------------------------dks lekIr oÂkZ@vof/k dh fjiksVZ
Report for the year/period ending……………………………………….

Hkkx& I/ PART – I
oS;fDrd C;ksjs@PERSONAL DATA

1. vf/kdkjh dk uke
Name of Officer

2. inuke@in ftl ij dke dj jgs gSa

Designation/Post held

3. tUe dh rkjh[k
Date of birth

4. D;k vf/kdkjh vuqlwfpr tkfr@vuqlwfpr tutkfr ds gSa \

Whether the Officer belongs to SC/ST

5. orZeku xzsM esa yxkrkj fu;qfDr dh rkjh[k

Present Grade

6. D;k LFkk;h@vLFkk;h vFkok LFkkukiUu gSa

Date of appointment to the present post

7. fjiksVZ dh vof/k ds oÂkZ fdu&fdu vuqHkkxksa esa dk;Z

fd;k rFkk gj ,d esa fdrus&fdrus le; rd dke fd;k A vuqHkkx vof/k
Section in which served during the year Section Period
Under report and period of service in each

8. oÂkZ esa NqV~Vh izf¿k{k.k vkfn ij gksus ds dkj.k M~;wVh ls

vuqifLFkfr dh vof/k
Period of absence from duty ( on leave,
Training etc.) during the year
 -: 2 :-
Hkkx &II/PART
& –II
LoewY;kadu@ SELF APPRAISAL

(ftl vf/kdkjh dh fjiksVZ fy[kh tk jgh gS mlds }kjk Hkjs tkus ds fy,)
(To be filled by the Officer Reported upon)

1. M~;wfV;ksa dk laf{Ir fooj.k

Brief description of duties

1. vkids }kjk ---------------------------ls---------------------------------rd ds oÂkZ@vof/k esa fd, x, dk;Z rFkk

oÂkZ@vof/k esa fo¿ksÂk miyfC/k;ksa dk lkjka¿k nhft, ;fn miyfC/k;ksa esa dksbZ deh jgh gks rks dkj.k
crka, A
(fn;k tkus okyk lkjka¿k uhps fn, x, LFkku esa vk tkuk pkfg, og 100 ¿kCnksa rd gksuk
pkfg, vkSj mlds uhps gLrk{kj fd, tkus t:jh gSa )
Brief resume of the work done by you during the year/period from ………… to
……………. bringing out any special achievements during the year/period. In the event
of shortfall in achievement furnish reasons. (The resume to be furnished within the space
provided limited to 100 words and is required to be signed)
 -: 3 :-
Hkkx &III/PART
& III
fjiksVZ fy[kus okys vf/kdkjh }kjk ewY;kadu
ASSESSMENT OF THE REPORTING OFFICER

( d`i;k izfofÂ;ksa dks Hkjus ls iwoZ] QkeZ ds var esa fn, x, vuqns¿kksa dks /;ku ls i<+ ysa)
(Please read carefully the instructions given at the end of the form before filling the entries)

1. D;k fjiksVZ fy[kus okyk vf/kdkjh Hkkx II esa fn, x, fooj.k ls lger gSa \ ;fn ugh arks og dgka rd
vlger gS rFkk mlds D;k dkj.k gSa A
Does the Reporting Officer agree with the statement made in Part II? If not the extent of
disagreement and reasons thereof.

2. LokLF;
State of health

3. lkekU; cqf)erk vkSj lh[kus dh yxu

General Intelligence and keenness to learn

4. Vad.k esa izoh.krk(xfr] rFkk ¿kq)rk nksuksa ds laca/k esa )

Proficiency in typing (in both speed and accuracy)

5. dk;Z vFkkZr~ fu/kkZfjr jftLVjksa rFkk pkV~Zl vkfn ds j[k&j[kko

Proficiency in work, namely maintenance of prescribed registers and charts etc.

6. cqf)erk] lh[kus dh yxu rFkk ifjJe¿khyrk

Intelligence, Keenness Industry

7. D;k mUgsa dHkh useh dk;Z ds vfrfjDr vU; dk;Z lkSaik x;k gS ;fn gka] rks viuh fVIif.k;ksa rFkk elkSnksa
esa fopkj LiÂVrk rFkk dq¿kyrk ds lkFk izdV djus dh mudh {kerk ds ckjs esa crk,a A
Has he ever been entrusted with work other than routine? if so, indicate his capacity to
express himself with clarity and comprehensive in his notes and drafts.

8. vuq¿kkluc)rk
Amenability to discipline

9. gkftjh esa le; dh ikcanh

Punctuality in attendance

10. lkFkh deZpkfj;kssa ds lkFk laca/k@tulEidZ(tgka ykxw gks)

Relations with fellow employees/Public relations(wherever applicable)
 -: 4 :-

11. D;k fjiksVZ dh vof/k esa ykijokgh ls dke djus ;k vU; dkj.kksa ls vf/kdkjh dh HkRlZuk dh xbZ gS
Has the officer been reprimanded for indifferent work or for the other causes during the
period under report?( If so, please give brief particulars).

12. D;k vf/kdkjh us iz¿kalk ;ksX; dksbZ mRd`ÂV ;k mYys[kuh; dk;Z fd;k gS \ mudk la{ski esa mYys[k djsa
Has the officer done any outstanding or notable work meriting commendations? Briefly
mention them.

13. lR;fuÂBk
Integrity
( d`i;k vuqns¿kksa ds uhps nh xbZ fVIi.kh ns[ksa )
(Please see Note below instructions)

14. dksfV fu/kkZj.k

Grading
(mRd`ÂV@cgqr vPNk@vPNk@vkSlr@vkSlr ls de )
(Outstanding/Very good/Good/Average/Below Average)
( fdlh vf/kdkjh dks rc rd mRd`ÂV dksfV ugha nh tkuh pkfg, tc rd fd mlesa mPp dksfV ds xq.k
rFkk dk;Z esa fuÂiknu ns[kus esa u vk;k gks] ftl vk/kkj ij ,slh dksfV nh xbZ gS] mldk LiÂV :i ls
myys[k fd;k tkuk pkfg,)
(An officer should not be graded outstanding unless exceptional qualities and
performance have been noticed, grounds for giving such a grading should be clearly
brought out).

fjiksVZ fy[kus okys vf/kdkjh ds gLrk{kj

Signature of the Reporting Officer
LFkku %
uke lkQ v{kjksa esa
Place: Name in block letters

fnukad % fjiksVZ dh vof/k esa inuke

Date: Designation (During the period of report)
 -:5:-
³ÖÖ÷Ö - 4 ¯Öã−Ö¸ü߁ÖÖ †×¬ÖúÖ¸üß «üÖ¸üÖ †×³ÖµÖãÛŒŸÖµÖÖÓ
PART-IV REMARKS OF THE REVIEWING OFFICER
1. ¯Öã−Ö¸ü߁ÖÖ †×¬ÖúÖ¸üß êú †¬Öß−Ö úß ÷Ö‡Ô ÃÖê¾ÖÖ úß †¾Ö׬Ö
Length of Service under the Reviewing Officer

2. ŒµÖÖ ¯Öã−Ö¸ü߁ÖÖ †×¬ÖúÖ¸üß ‡ÃÖ ²ÖÖŸÖ ÃÖê ÃÖÓŸÖã™ü Æîü ׍ú ׸ü¯ÖÖê™Ôü ׻֏Ö−Öê ¾ÖÖ»Öê †×¬ÖúÖ¸üß −Öê †¯Ö−Öß ×¸ü¯ÖÖê™Ôü ˆ×“ÖŸÖ ÃÖÖ¾Ö¬ÖÖ−Öß †Öî¸ü ¬µÖÖ−Ö êú ÃÖÖ£Ö ŸÖ£ÖÖ
ÃÖ³Öß ÃÖÓ÷ÖŸÖ úÖµÖÖí úÖê ¬µÖÖ−Ö ´Öë ¸üÖŸÖê Æãü‹ ¤üß Æîü…
Is the Reviewing Officer satisfied that the Reporting Officer has made his/her report with due care and
attention and after taking into account all the relevant material?

3. ŒµÖÖ †Ö¯Ö ׸ü¯ÖÖê™Ôü ׻֏Ö−Öê ¾ÖÖ»Öê †×¬ÖúÖ¸üß «üÖ¸üÖ ×ú‹ ÷Ö‹ †×¬ÖúÖ¸üß êú ´Ö滵ÖÖӍú−Ö ÃÖê ÃÖÆü´ÖŸÖ Æïü? †ÃÖÆü´ÖŸÖ ÆüÖê−Öê ¯Ö¸ü éú¯ÖµÖÖ ‡Ã֍úÖ úÖ¸üÖ
²ÖŸÖÖ‹Ó ? ŒµÖÖ úÖê‡Ô ‹êÃÖß ²ÖÖŸÖ Æîü וÖÃÖê †Ö¯Ö ãú”û ²Ö¤ü»Ö−ÖÖ µÖÖ •ÖÖê›Íü−ÖÖ “ÖÖÆêü÷Öë ?
Do you agree with the assessment of the officer given by the Reporting Officer? (in case of
disagreement, please specify the reasons : Is there anything you wish to modify or add?)

4. וÖÃÖ †×¬ÖúÖ¸üß úß ×¸ü¯ÖÖê™Ôü ׻֏Öß •ÖÖ ¸üÆüß Æîü µÖפü ¾ÖÆü †−ÖãÃÖæ×“ÖŸÖ •ÖÖןÖ/†−ÖãÃÖæ×“ÖŸÖ •Ö−Ö•ÖÖ×ŸÖ úÖ Æîü ŸÖÖê éú¯ÖµÖÖ ‡ÃÖ ²ÖÖŸÖ úÖê ×¾Ö¿ÖêÂÖ ºþ¯Ö ÃÖê
²ÖŸÖÖ‹Ó ×ú ŒµÖÖ †−ÖãÃÖæ×“ÖŸÖ •ÖÖןÖ/†−ÖãÃÖæ×“ÖŸÖ •Ö−Ö•ÖÖ×ŸÖ êú †×¬ÖúÖ¸üß êú úÖµÖÔ-×−Ö¯ÖÖ¤ü−Ö úÖ ´Ö滵ÖÖӍú−Ö ú¸üŸÖê ÃÖ´ÖµÖ ˆÃ֍úÖ ¥üÛ™üúÖêÖ −µÖÖµÖ¯ÖæÖÔ
ŸÖ£ÖÖ ˆ×“ÖŸÖ ¸üÆüÖ Æîü…
If the officer reported upon is a member of Scheduled Caste/Tribe, please indicate specifically whether the
attitude of the Reporting Officer in assessing the performance of the SC/ST Officer has made fair and
just.

5. ׸ü¯ÖÖê™Ôü ׻֏Ö−Öê ¾ÖÖ»Öê †×¬ÖúÖ¸üß «üÖ¸üÖ ¤üß ÷Ö‡Ô ÃÖÖ´ÖÖ−µÖ †×³ÖµÖãÛŒŸÖµÖÖêÓ êú ²ÖÖ¸êü ´Öë ×¾Ö׿Ö™ü ×™ü¯¯Ö×ÖµÖÖë êú ÃÖÖ£Ö ÃÖÖ´ÖÖ−µÖ †×³ÖµÖãÛŒŸÖµÖÖÓ †Öî¸ü úÖê×™ü
×−Ö¬ÖÖÔ¸üÖ †×¬ÖúÖ¸üß êú ÃÖ¸üÖÆü−ÖßµÖ úÖµÖÔ êú ²ÖÖ¸êü ´Öë †×³ÖµÖãÛŒŸÖµÖÖÓ…
General remarks with specific comments about the general remarks given by the Reporting Officer and
remarks about meritorious work of the officer including the grading.

6. ŒµÖÖ †×¬ÖúÖ¸üß ´Öë ‹êÃÖß úÖê‡Ô ×¾Ö¿ÖêÂÖŸÖÖ‹Ó Æïü †Öî¸ü µÖÖ úÖê‡Ô µÖÖê÷µÖŸÖÖ‹Ó Æïü וÖ−֍êú úÖ¸üÖ ×¾Ö¿ÖêÂÖ úÖµÖÔ êú ×»Ö‹ ˆ−֍úÖ “Öã−ÖÖ •ÖÖ−ÖÖ µÖÖ ²ÖÖ¸üß −Ö ÆüÖêŸÖê
Æãü‹ ³Öß ˆ−֍úß ¯Ö¤üÖê®Ö×ŸÖ ˆ×“ÖŸÖ ÆüÖê? µÖפü ÆüÖÓ, ×¾Ö¿ÖêÂÖ ºþ¯Ö ÃÖê ²ÖŸÖÖ‹Ó?
Has the officer any special characteristics, and/or abilities which would justify his/her selection for special
assignment or/out of turn promotion? If so, specify.

¯Öã−Ö¸ü߁ÖÖ †×¬ÖúÖ¸üß êú ÆüßÖցָü

Signature of the Reviewing Officer

−ÖÖ´Ö ÃÖÖ±ú †Ö¸üÖë ´Öë

Name in Block Letters
ãÖÖ−Ö:
Place:
ŸÖÖ¸üߏÖ:
Date: ׸ü¯ÖÖê™Ôü úüß †¾Ö×¬Ö ´Öë ¯Ö¤ü−ÖÖ´Ö
Designation (During the period of report)