Free 52404.pdf - Indiana

INTERIM PERFORMANCE APPRAISAL
(SHORT FORM)
State Form 52404 (R / 10-08)

This form is an optional communication tool to be used during the annual review period.

Name of Employee Agency/Division

Name of Supervisor Review Period From

to

PERFORMANCE SUMMARY ­ Performance Expectations / Goals A. Summarize performance to-date for all performance expectations

B. Identify any new expectations or make modifications based on changed circumstances.

PERFORMANCE SUMMARY ­ Competencies
(Summarize performance to date for all Competencies)



DEVELOPMENT NEEDS
(Status update of agreed upon training needs and or any additional training/resources needed to assist in meeting current goals in next 3-6 months)



EMPLOYEE COMMENTS
(Include comments about and/or needs from supervisor)



Signature of Employee Signature of Supervisor

Date (month, day, year) Date (month, day, year)