Supervisor’s Performance Feedback Form

Department of Human Resources & Equal Opportunity 1246 W. Campus Rd, Room 103 I Lawrence, KS 66045-7521 I (785) 864-4946 I Fax (785) 864-5790 I I 5/2009 | Page 1 of 5 supervisor s Performance Feedback Form Department: Evaluation Date: Evaluation Period: 1. Immediate supervisor Name: 2. supervisor s supervisor Name: 3. Dean/Department Head Name: 4. Name and Signature of Evaluator (optional): Departments are encouraged to establish a system of Performance evaluation Feedback for supervisors by staff that reflects an impartial input to each supervisor regarding his/her Performance . Formal Feedback can be a positive means to assist the supervisor in improving job Performance . Feedback affords staff members the opportunity to clarify what they expect of the supervisor in fostering a work climate that helps to attain the goals of the department. supervisor Performance Feedback should be conducted on a periodic basis (at least annually) and should not reflect personal prejudice, bias, or favoritism on the part of the staff member for the rating or review.

1. Immediate Supervisor Name: 2. Supervisor’s Supervisor Name: 3. Dean/Department Head Name: 4. Name and Signature of Evaluator (optional): Departments are encouraged to establish a system of performance evaluation feedback for supervisors by staff that reflects an impartial input to each supervisor regarding his/her performance.

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