pa questionnaire 136

8/6/2019 Pa Questionnaire 136

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PERFORMANCE APPRAISAL QUESTIONNAIRE

A. PERSONAL PARTICULARS (To be completed by the Supervisor)

ID Number Date of birth

Surname: ………………………………………………………………………………………………

First name(s): …………………………………………………………………………………………

Salary level: ………………………………….. Rank: …………………………………………..

Entry date to the rank or grading: …………. Dept.: …………………………………………..

Division: ……………………………………… Stationed at: …………………………………..

Persal/Salary No.: ………………………….. District Office: …………………………………

B.1-3 MUST BE COMPLETED BY THE OFFICIAL

B.1 EDUCATIONAL QUALIFICATIONS

(a) Highest standard passed at school:(b) Post-school qualifications Year Major subjects

………………………………………….………………………………………….………………………………………….………………………………………….

……..……..……..……..

…………………………………………….…………………………………………….…………………………………………….…………………………………………….

B.2 PREVIOUS AND PRESENT EXPERIENCE IN THE PUBLIC SERVICE

From To Department Occupational Class…………….

…………….…………….…………….

……………

………………………………………

………………………………

………………………………………………………………………………………………

………………………………………

………………………………………………………………………………………………………………………

B.3 DECLARATION

I declare that the information above is true and correct, that I am aware that it will be noted inthe records and I undertake to notify the personnel division of any changes, that may occur.

___________________________ ___________SIGNATURE DATE




C.1 ASSESSMENT SCALE

Points Description of norm1

23

Noticeably better than the normal requirements

Considerably better than the normal requirementsExcellent

C.2

Points awardedElement Description Reporting

officerAssessingcommittee

Skills The acquired abilities which enable an employee to perform theduties attached to his or her post.

Knowledge The knowledge necessary to perform the duties attached to hisor her post in terms of (a) in-depth knowledge of a variety of

aspects or fields, and (b) specialised knowledge of (a) specificaspect(s) or field(s).

Experience The experience/expertise an employee needs to perform theduties attached to his or her post.

Training Applicable training which has been acquired in various ways,e.g. in-service training and specific job oriented courses.

Qualifications Applicable formal qualifications obtained at educationalinstitutions e.g. schools, technikons and universities.

Performance * The demonstrated ability to utilise acquired skills, knowledgeand experience and which clearly distinguishes a person fromhis or her peer group.

TOTAL

* Performance should always be included as one of the factors to be evaluated.

C.3 VALUE DETERMINATIONPlease indicate with an X in the applicable box:

Number of elementsused

Second notch Reportingofficer

Assessingcommittee

Third notch Reportingofficer

Assessingcommittee

4 9 10-125 11 13-156 13 16-18

C.4 STATEMENT

STATEMENT BY REPORTING OFFICER STATEMENT BY OFFICIAL WHO IS BEINGEVALUATED

I hereby declare that the attached personal profilequestionnaire in respect of _____________________ has been completed by me.

___________ _____________ __________ SIGNATURE RANK DATE

1. I hereby confirm that the information above is trueand correct, that my supervisor has discussed thecontents of the personal profile questionnaire with meand that I have taken note of the assessment.2. I hereby also take note that I do or do not qualifyfor nomination for a performance appraisal(*delete which is not applicable).

___________ _____________ __________ SIGNATURE RANK DATE




D.1 RECOMMENDATION OF THE COMMITTEE DEALING WITH THE PRELIMINARYASSESSMENT

The committee that dealt with the preliminary assessment of the official recommends/does not recommend

his/her case for final evaluation by the relevant assessing authority. If his/her case is not recommended, pleasestate the reasons: _________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Signature of the Chairperson of the committee for preliminary assessments:

_______________ ___________________ _________ _____________________________ SIGNATURE RANK DATE DIRECTORATE/DISTRICT OFFICE

D.2 RECOMMENDATION BY THE ASSESSING AUTHORITY

After the final evaluation of the candidate the Assessing Authority decided to recommend/not to recommend theallocation of a second or third notch for which he/she was nominated.

Remarks: _______________________________________________________________________________

________________________________________________________________________________________

Signature of the Chairperson of the Assessing Authority:

_______________ __________________________ ________________ SIGNATURE RANK DATE

E. COMMENTS BY THE HEAD OF DEPARTMENT (OR HIS OR HER DELEGATE)

Approved/Not approved/Approved as amended

Comments:

…..………………………………………………………………………………………………………

…..………………………………………………………………………………………………………

______________________________ ______________SIGNATURE DATE

pa questionnaire 136

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