BASE SYSTEM CIVILIAN EVALUATION REPORT - …

1 A. NAME OF RATER (Last, First, Middle Initial)d. ORGANIZATION/INSTALLATIONBASE SYSTEM CIVILIAN EVALUATION REPORTFor use of this form, see AR 690-400; the proponent agency is ASA(M&RA)DA FORM 7223, AUG 1998 BULLET COMMENTS VALUES Loyalty Duty Respect Selfless service Honor Integrity Personal couragePREVIOUS EDITION IS I - ADMINISTRATIVE DATAb. SSNc. POSITION TITLE, PAY PLAN, SERIES AND GRADEe. REASON FOR SUBMISSIONANNUALSPECIALPART II - AUTHENTICATIONSIGNATUREDATEb.

2 NAME OF INTERMEDIATE RATER (Optional)(Last, First, MI)SIGNATUREDATEc. NAME OF SENIOR RATER (Last, First, Middle Initial) (If used)SIGNATUREDATEd. RATEE: I understand my signature does not constitute agreement or disagreement with the evaluations of the Rater and Senior Rater, and merely verifies Part I and Part IV OF RATEEDATEPART III - PERFORMANCE AWARD/QUALITY STEP INCREASEPERCENT OF SALARY(EXCLUDES Locality Pay) % (OR)AMOUNT $ AWARD APPROVED BYDATE (YYYYMMDD)PART IV - DUTY DESCRIPTION (Rater) a.

3 DAILY DUTIES AND SCOPE (To include as appropriate: people, equipment, facilities, and dollars). Position Description is correct: INITIALCOUNSELING DATES FROM CHECKLIST/RECORDLATER (Optional)MIDPOINTLATER (Optional) PERIOD COVERED (YYYYMMDD)g. RATED RATEE COPY (Check one and date)GIVEN TO RATEEFORWARDED TO RATEEYESNOAPD V - VALUES (Rater) (GS with Successful Level 1 Rating Only - minimum of 52 weeks must have elapsed since last QSI) (Grade/Step)FROMTHRUGRADE/RANK, ORGANIZATION, DUTY ASSIGNMENTGRADE/RANK, ORGANIZATION, DUTY ASSIGNMENTGRADE/RANK, ORGANIZATION, DUTY ASSIGNMENTFUND CITEb.

4 AREAS OF SPECIAL EMPHASIS(OR)QSITOa. NAME (Last, First, Middle Initial)Numbers 5 and 6 apply to positions with some supervisory dutiesEXCELLENCE(Exceeds std)SUCCESS(Meets std)NEEDS IMPROVEMENTFAILSRATEE'S NAME (Last, First, Middle Initial)SOCIAL SECURITY NUMBERTHRU DATEb. RESPONSIBILITIESS pecific bullet examples of other than "SUCCESS," are bullet examples of "SUCCESS" are optional but TECHNICAL COMPETENCET echnical knowledges, skills, abilitiesDoing work right/on timeSound judgementEXCELLENCE(Exceeds std)SUCCESS(Meets std)NEEDS IMPROVEMENTFAILS2.

5 ADAPTABILITY AND INITIATIVEA djusting to change - situations/peopleTrying new thingsSeeking self-developmentEXCELLENCE(Exceeds std)SUCCESS(Meets std)NEEDS IMPROVEMENTFAILS3. WORKING RELATIONSHIPS & COMMUNICATIONSEXCELLENCE(Exceeds std)SUCCESS(Meets std)NEEDS IMPROVEMENTFAILS4. RESPONSIBILITY AND DEPENDABILITYD ependable/reliableMaintaining facilities/equipmentConserving supplies/timePeople/equipment safetyEXCELLENCE(Exceeds std)SUCCESS(Meets std)NEEDS IMPROVEMENTFAILS5. SUPERVISION AND LEADERSHIP Mission focused/performance orientedSets standard/Leads by exampleMotivating/developing othersImplementing DA emphasis programs/managing resourcesEXCELLENCE(Exceeds std)SUCCESS(Meets std)NEEDS IMPROVEMENTFAILS6.

6 EEO AND AFFIRMATIVE ACTIONR especting dignityAchieving planned actionsProviding opportunitySolving problemsPART VI -SENIOR RATER (if used) or RATER (no senior rater used) OVERALL PERFORMANCE UNSUCCESSFUL(MUST Have Senior Rater Review)FAIR SUCCESSFULREVERSE, DA FORM 7223, AUG 1998 BULLET COMMENTS (Performance/Potential)APD VII - SENIOR RATER (If used) 1 2 345A completed DA Form 7223-1 was received with this REPORT YESNO (Explain)Supporting teamRespecting othersExpressing ideas clearlyListening/understanding