Employee Self-Assessment

Employee's First Name

Employee's Last Name

Email Address

Self Assessment

How would you rank your work performance overall?

Very GoodGoodFairPoorVery PoorNot Applicable

Evaluate the Following

I have a positive attitude towards my job, my co-workers and Successful Solutions? 

Totally AgreeStrongly AgreeAgreeDisagreeStrongly Disagree

I know and understand the responsibilities of my job.

Totally AgreeStrongly AgreeAgreeDisagreeStrongly DisagreeNot yet

During my work shift, I am/will be in my designated work space, and focused.

Totally AgreeStrongly AgreeAgreeDisagreeStrongly Disagree

I'm able to focus on work and keep distractions to a minimum.

Totally AgreeStrongly AgreeAgreeDisagreeStrongly Disagree

I am/will be logged on and ready to work 5 minutes before my shift.

Totally AgreeStrongly AgreeAgreeDisagreeStrongly Disagree

I don't/won't conduct personal phone calls during my work shift. 

Totally AgreeStrongly AgreeAgreeDisagreeStrongly Disagree

If personal matters need to be attended to during work hours, I take (or will take) my 10 minute break, or request an unpaid break, to handle them.

Totally AgreeStrongly AgreeAgreeDisagreeStrongly Disagree

I don't/won't use drugs or alcohol  during my work shifts.

Totally AgreeStrongly AgreeAgreeDisagreeStrongly Disagree

If I have an urgent personal phone call, I take (or will take) a break (paid or unpaid) to attend to it.

Totally AgreeStrongly AgreeAgreeDisagreeStrongly Disagree

I feel that my workload IS or may be heavier than it needs to be.

Totally AgreeStrongly AgreeAgreeDisagreeStrongly Disagree

Do you understand the requirements of your job? What aspects of your job need clarification?

What are your strengths (the things that you do well) and how do you can put them to use in your job? 

What are your weaknesses and how can they impact your job? 

What would enhance your performance (training, equipment, etc.)?

What are your work goals for the next year, and what action will you take to accomplish those goals?

What could your supervisors do to support you in your job?