PERFORMANCE ASSESSMENT FORM

PERSONAL PROFILE
(ANNEXURE)

Please fill in the details about yourself:

Name: Designation:

Grade: Department:

Location of Work: Division

Date of Joining : Reporting to:

Define your Responsibilities:

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Kindly Draw your Departmental Structure:

Head Of the Division

Departmental Head

POLYGEL TECHNOLOGIES (I) PVT LTD

PERFORMANCE ASSESMENT FORM
KRA Based Assessment: Kindly refer to you PPF Sheet (Part 1)
Key Result Areas Achievement for the year Self HOD/CMD
towards KRA Rating Rating
Scale 1-4 Scale 1-4
1

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Total > (A)
Performance Rating Indicator ( PRI )
4 = Excellent ( Performed absolutely beyond expected level of KRA )
3 = V Good ( Performed as per expected level of KRA)
2 = Good ( Performed just below Expected level of KRA )
1 = Average ( Performed below expected level of KRA )
Note : Please sit along with your HOD and duly draw out five main Key Result Areas as
expected from you and also write the achievement along with rating as mentioned in PRI.
Competency Based Assessment: (Part-2 / A)

For Managers Level & Above (M3 >):

Sl No Functional Competency Self Rating HOD/MD Rating
 Scale 1-4 Scale 1-4
1 Leadership
2 Strategic & Analytical Thinking
3 Problem Solving
4 Decision Making
5 Customer Focus & Service
Total (B) ** Refer CRI as given below

Competency Based Assessment: (Part-2 / B)

Sl No Behavioral Competency Self Rating HOD/MD Rating

Scale 1-4 Scale 1-4
1 Inter-personal
2 Communication
3 Team
4 Sub-ordinate Development
5 Perseverance
Total (B) ** Refer CRI as given below

Personal Development Plan: Training Needs (Part 3)

Name of the Training Tick Mark Specify for Remarks by HOD
Program (Self) Functional Training
Attitude Based:
Assertiveness Skill
Personality Development
Lateral Thinking
Interpersonal Skill
Team Work
Knowledge (Functional)
Accounts & Finance
Sales & Marketing
Purchase
Material handling
PPC
QC/QA
Skills
Communication Skills
IT Skills
Leadership skill
Time Management

**Competency Rating Indicator for Competency Based Assessment ( CRI )

4 = Excellent ( Competency absolutely beyond expected level )
3 = V Good ( Competency as per expected level )
2 = Good ( Competency just below Expected level )
1 = Average ( Competency below expected level )

Performance Summary Self ( Part-4)

Total Score on KRA Assessment Part (1) x 5

Total Score on Competency Assessment Part(2-A) x 5

Total Score on Competency Assessment Part(2-B) x 5

Overall Rating:
Add Part 1 + Part 2-A + Part 2- B listed above and divide the
total by 3 . Fill the result in the provided space

Assessees Comments :
State your perception of your overall performance during this review cycle . Include
accomplishment not identified anywhere in the form and describe performance areas you
would like to develop . If you have marked disagree with the reviewer describe your reason

Signature Date :

Performance Summary HOD / MD (Part-5)

Assessor Comments: (HOD)

Signature: Date:

Reviewers Comments: (MD)

Signature: Date: