PERFORMANCE PPRAISAL PERFORMA

FOR CONTRACTUAL STAFF RECRUITED FOR SHS(D) & IDHSs UNDER DSHM

PROFORMA No. ____ (FOR THE POST OF DISTRICT TRAINING COORDINATOR)

(Duration of the period reported upon: from _____________ to _______________)

Part-I to be filled in by the Employee:

1. Name of the officer/official
(Full Name in Block Letters) : : _______________________________________

2. Name of Spouse/ Parent : ________________________________________

3. Designation : ________________________________________

4. Qualification : _________________________________________

5. Date of Initial appointment : _________________________________________

on contract basis:

6. Period of absence from duty : ______________________________________

a. Sanctioned Leave __________________________________________
b. Any other reason __________________________________________

7. Resume of the work done :

(To be filled in by the employee)

Sr. No. Activity Achievement Constraints Not

If any applicable
1. No. of employees in the district whose TNA is
done.
2. No. of training organised against planned.
3 % of training session monitored
4 Date of submission of SOE by 5th of every month.
5. Date of submission of monthly training report to
DPO by 5th of every month.
6. % of employees evaluated after Training
7. HR mapping of trained employees

8 (A) Please state briefly, the shortfalls with reference to the targets/objectives/goals
referred to in item 7. Please specify constraints, if any, in achieving the targets.
______________________________________________________________________________
______________________________________________________________________________
1
______________________________________________________________________________
______________________________________________________________________________

8.(B) Any special contribution/achievement

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Dated : Signature of Employee

__________________ _____________________________

PART-2(A) To be filled in by the reporting officer (weightage to this section would be 70%)

Sr. Activity Assessment Tool Score Not

No. applicable
1 2 3
1. No. of employees in the district 60% 60-90% 90-100%
whose TNA is done.
2. No. of training organised against 60% 60-90% 90-100%
planned.
3 % of training session monitored 60% 60-90% 90-100%
4 Date of submission of SOE by 5th of 60% 60-90% 90-100%
every month.
5 Date of submission of monthly 60% 60-90% 90-100%
training report to DPO by 5th of
every month.
6. % of employees evaluated after 60% 60-90% 90-100%
Training
7. HR mapping of trained employees 60% 60-90% 90-100%
Total Score on Performance

PART-2 (B) Assessment of personal /functional attributes (weightage to this section would
be 30%)

Reporting Authority Reviewing Authority Initial of

(Assessment Scale 1 to (Assessment Scale 1 to Reviewing
5) 5) Authority

2
 (1) (2) (3) (4)

i) Punctuality & discipline

ii) Attitude/behavior towards
a) patients/public
b) Seniors
c) Colleagues
d) Subordinate
iii) Ability to coordinate and
work in a team
iv) Reliability/sense of
responsibility
v) Communication Skills
vi)Accuracy and quality of
output
vii) Ability to meet deadline
viii) Knowledge level in the area
of work
ix) Level of technical skill in the
area of work
x) Knowledge level of govt.
rules & procedures related in
general and in the area of work.
xi) No. of times & days
unauthorized leave availed
xii) Any advisory/memo given
to the employee during existing
contract period.
If, yes copy may be attached.
Score on ‘Personal Attributes’

Overall numerical grading of employee: Weightage to Performance (Part-2A) is 70% and

Personal / functional attributes (Part-2B) is 30%.

(a) Outstanding (75% or above)

(b) Very Good (61-74%)
(c) Good (50 - 60%)
(d) Average (41- 49%)
(e) Unsatisfactory (40% & below)
(Assessment of officer’s overall work in his/her particular position) & Comments,
Recommendations for renewal of contract:
_____________________________________________________________________________________
_________________________

3
_____________________________________________________________________________________
_________________________
_____________________________________________________________________________________
_________________________
_____________________________________________________________________________________
_________________________
_____________________________________________________________________________________
_________________________
_____________________________________________________________________________________
_________________________

Signature of Reporting Officer

Place:………….. Name in Block Letters:………………………….

Date:……………….. Designation:……………… tamp..…………….

4
PART-3: (To be filled in by reviewing officer)

(A) Length of service under the Reviewing Officer:

(B) Comments of Reviewing Officer

_____________________________________________________________________________________
______________________
_____________________________________________________________________________________
______________________
_____________________________________________________________________________________
_______________________
_____________________________________________________________________________________
_______________________
_____________________________________________________________________________________
_______________________

Final Grading of Employee: Weightage to Performance (Part-2A) is 70% and Personal /

functional attributes (Part-2B) is 30%.

(a) Outstanding (75% or above)

(b) Very Good (61-74%)
(c) Good (50-60%)
(d) Average (41-50%)
(e) Unsatisfactory (40% & below)

Signature of Reviewing Officer

5
 (Name in block letters)
with Stamp
Date : _________________

______________________________________________________________________________
_______________________

Note: (Guidelines for Reporting/ Reviewing Officer)

Reporting Officer (to complete Part-2) - MOI/C, In-Charge Mty. Home/Prog./ Nodal Officer/
Head of Deptt.
Reviewing Officer(to complete Part-3):- MS, CDMO
* This is indicative list (may not be exhaustive).

HOW TO DO ASSESSMENT FOR POINTWISE SCORE AND OVERALL GRADING FOR THE
POST OF DISTRICT TRAINING COORDINATOR, NRHM

1. Part-1: of the Performa will be filled by the Concerned Employee, where from Point 1 to 6, personal
details will be filled up.

2. In Point No. 7: A table is given where employee will fill his work output related parameters.
a) In activity column, activities being performed by the employee are given.
b) In next column performance achieved by the employee will be filled up, some of the responses are date
specific and may be dealt accordingly.
c) If any employee feels there was bottleneck / constraint in achieving the desired output in any activity
which is beyond his / her control the same may be mentioned in the constraint column against that
activity.
d) If any of the activity is not being performed by the employee N.A. may be mentioned in not applicable
column.

3. Point No. 8 (A & B): The employee can write briefly about shortfalls etc. which could not be mentioned
in the table at Point No. 7 above, at point no. 8-A and any special contribution / achievement may be
mentioned in at point no. 8-B respectively.

4. Part-2 to be filled up by the Reporting officer: It has two parts:

The Part 2-A: Activity column is showing activities to be performed by employee and Score Assessment
Tool is given in next three columns and depending upon the level of the activity achieved the Reporting

6
 Officer will assess the performance of the employee on the score scale of 1 to 3 and mark accordingly in
score column. If any of the activity is not being performed by the employee N.A. may be mentioned in
not applicable column.
The Part 2-B: will be filled by the reporting officer and is covering the personal & functional attributes of
the employee. Reporting officer will assess the employee on a score scale of 1 to 5 for every attribute
and sub-attribute where 1 is the lowest and 5 is the highest score and mark accordingly in the column of
reporting against each attribute.

5. Weightage Criteria: Weightage for the Part-2 A is 70% and Part-2 B is 30%.

6. Grading of performance: Overall Grading to be given by Reporting Officer & Final Grading to be
given by Reviewing Officer. In case Reviewing Officer disagrees with the overall grading of Reporting
Officer the same may be changed in final grading giving appropriate comments in the provided space.

(a) Outstanding (75% or above)

(b) Very Good (61-74%)
(c) Good (50-60%)
(d) Average (41- 50%)
(e) Unsatisfactory (40% & below)

7. Recommendations:- The Controlling Officer is requested to recommend renewal of the

employee whose overall grading are Outstanding, Very Good and Good. If grading is average or
unsatisfactory and Controlling Officer is convinced that the reasons for poor performance are beyond
the control of the concerned employee (Highlighted in the bottlenecks/constraints by the employee) he
can recommend for renewal of contract or otherwise giving justification. If the overall grading is
‘Average’ and “Unsatisfactory’ and there were no constraints then reporting officer will communicate to
the employee for improving the performance in writing and employee may again be reviewed after
sometime or may not recommend for renewal of contract.

8. PART-3: (To be filled in by reviewing officer): While reviewing, if the officer thinks otherwise
with the assessment scoring of reporting officer of the employee given in Part-2 B (above), may give own
review scoring in the column no. 3 accordingly. The comments may be given in the provided space. Final
grading will be made after reviewing.