PRIVATE AND CONFIDENTIAL

THE BEST HEALTH CENTRE

APPRAISAL FORM

SECTION 1

NAME: ________________________________________________________

JOB TITLE: ________________________________________________________

DATE, TIME AND PLACE OF INTERVIEW: _____________________________

NAME OF LINE MANAGER: _________________________________________

APPRAISAL PROCESS

Prior to your appraisal interview, please complete Section 2 of the attached form. As
your line manager, I will also think about these questions in relation to your past and
your future development with the Health Centre. When we meet, we will discuss all
the areas and complete Section 3 together, then set up a review meeting.

The information you write on the forms is not to be handed in but used for discussion
only with myself.

If you have any queries or questions, please do not hesitate to ask.

SECTION 2

1. Summarise briefly how you feel you have contributed to the smooth running
of the organisation over the past year.

2. What do you feel have been your main achievements with particular
reference to the Practice Plan?

3. What do you feel have been your main areas of difficulty?

4. How could these have been overcome?

5. What particular strengths do you feel you have and to what extent are they
being used?

6. What weaknesses, if any, do you have in fulfilling the responsibilities of your

job?

7. How would you assess your own ability to be organised and get things done?

8. How flexible, adaptable and committed are you?

9. Have you been able to help with any problems your colleagues may have
experienced in relation to their job?
10. How would you describe your relationship with all your colleagues?

11. How would you describe your relationship with the patients?

12. What do you like most and least about your job?

13. How challenging do you find your current position?

14. Do you have any capabilities or interests which you feel might be better used
than at present?

15. Are you aware of the relevance of any training you have undertaken over
the past year in relation to your job? - give an example.

16. In what areas do you think you could improve your performance?

17. What changes do you think could be made to alleviate any difficulties,
weaknesses and pressure and enable you to use your strengths to make
your job more enjoyable/challenging?

18. Have there been improvements in the way the organisation has developed
over the past year?
19. How have you contributed towards these improvements?

20. Do you feel that we provide enough assistance to help you develop?

21. What do you see yourself doing within

a) the next 2 years?

b) the next 5 years?

22. What do you feel could prevent you from achieving the above?

23. What are your key work targets for the next year?

24. What training is needed to meet these work targets?

25. Are there any additional points in respect to your job which you would like
to
discuss?

THE BEST HEALTH CENTRE

SECTION 3: ACTION PLAN FOR JAN 2004/2005

NAME: __________________________________________________________

JOB TITLE: _______________________________________________________

DATE OF INTERVIEW: _____________________________________________

NAME OF LINE MANAGER: ______________________________________

_____________________________________________________________________
1. KEY ACHIEVEMENTS SINCE LAST REVIEW

_____________________________________________________________________
2. KEY WORK TARGETS FOR NEXT PERIOD

_____________________________________________________________________
3. NEW RESPONSIBILITIES (if any)

_____________________________________________________________________
4. ADDITIONAL ACTION POINTS (if any)______________________________

5. TRAINING AND DEVELOPMENT NEEDS

_____________________________________________________________________

NEEDS OBJECTIVE(S)
_____________________________________________________________________

6. ADDITIONAL COMMENTS

_____________________________________________________________________
REVIEW DATE:______________________________________________________

LINE MANAGER’S SIGNATURE ......................................... DATE ..................

EMPLOYEE’S SIGNATURE ................................................... DATE ..................

Issue a copy to the employee and set the next review date, depending on the
information above.

THE BEST HEALTH CENTRE

APPRAISAL PROCEDURE

PURPOSE

To carry out an annual appraisal, using the forms, preparing in advance and then
carrying out as many reviews as necessary.
SCOPE

All employees and GP’s at Insch Health Centre.

PROCEDURE

INITIAL APPRAISAL

1. Once a year, the line managers will raise the staff appraisal forms for
each
employee, who reports directly to them.

2. The line manager will arrange a face to face meeting with the employee no
less than 7 days in advance, then give them a copy of the appraisal form with
Section 1 completed.

3. The line manager will ask the employee to prepare for the meeting by writing
down their thoughts under each point in Section 2 on the form.

4. The line manager will also prepare for the meeting by writing down their
thoughts on the employee under each point in Section 2 on the form.

5. The meeting should happen in an environment that is not threatening for the
employee and is free from interruptions.

(initially the first such meeting may take up to 2 hours per employee, but
should be contained within 1 hour thereafter).

6. The meeting should be a slightly formal/informal meeting where both parties

are relaxed and at ease with one another.

7. Working through each of the points in Section 2, the line manager should ask
the employee what they think, listen to the answer, then respond with any
additional thoughts of their own. (Note: most employees are harder on
themselves than their line manager and this often gives the line manager an
opportunity to conduct the interview in a very positive manner. If however, a
line manager needs to give negative feedback, this should not be new
feedback to the employee, it should be given constructively with examples and a
development action would normally be the result to help the person do better
the ‘next time’.

8. At the end of the meeting a maximum of 15 minutes should be kept for the
line manager to complete Section 3 of the Action Plan, in conjunction with the
employee.

9. Once the action plan is completed with the review date (can be month, exact
date to be confirmed nearer time) both parties write in their comments and
sign the form. The line manager will pass the original to the Practice
Manager and give the employee a copy. This will form the basis for the
Practice Manager to write a Training Plan in conjunction with the employee.
The original action plan and the line managers notes can then be kept in the
 employees personnel file. The line manager should enter a diary note at the
beginning of the month, when the next review is to take place.

REVIEWS

10. When a review is due the line manager should arrange a face to face meeting
with the employee no less than 7 days in advance. Ask them to look over the
action plan and prepare any notes for discussion at the meeting. The line
manager should also prepare for the meeting. The meeting should happen in
an environment that is not threatening for the employee and is free from
interruptions (the review meeting should take no more than 30 minutes).

11. The meeting should be a slightly formal/informal meeting where both parties
are relaxed and at ease with one another.

12. The line manager should start discussion on how the work targets are doing,
and set any additional targets then discuss any new responsibilities or
additional action points. Finally, review what training and development
needs have been completed/not completed or not needed now and set any new
training and development needs. All the information should be recorded on
the appraisal review form with the next review date (can be just the month -
date confirmed nearer time). Any comments can be documented and both
parties sign the form. The original can be kept in the employees personnel file
and a copy given to the employee. The line manager should enter a diary
note at the beginning of the month, when the next review is to take place.

13. The procedure points 10,11 and 12 should be followed for each review carried
out until the next full appraisal takes place.

THE BESTHEALTH CENTRE

APPRAISAL REVIEW FORM

NAME: ___________________________________________________________

JOB TITLE: ________________________________________________________

DATE OF INTERVIEW: _____________________________________________

NAME AND TITLE OF LINE MANAGER: _____________________________

_____________________________________________________________________
_1.__REVIEW OF KEY WORK TARGETS _____________________
 ADDITIONAL TARGETS SET

_____________________________________________________________________
2. REVIEW OF NEW RESPONSIBILITIES/ADDITIONAL ACTION POINTS
___(if
any)____________________________________________________________

_____________________________________________________________________
3. REVIEW OF TRAINING AND DEVELOPMENT NEEDS________________

ADDITIONAL TRAINING AND DEVELOPMENT NEEDS SET

_____________________________________________________________________
_____________NEEDS_________________________OBJECTIVE(S)__________

_____________________________________________________________________
4. COMMENTS (LINE MANAGER AND/OR EMPLOYEE)________________

_____________________________________________________________________
NEXT REVIEW DATE:________________________________________________

LINE MANAGER’S SIGNATURE ____________________ DATE ___________

EMPLOYEE’S SIGNATURE __________________________DATE___________

Issue a copy to the employee and set the next review date, depending on the
information above.