Dated: Name & Sig. ANNUAL CONFIDENTIAL …

1 1 Dated: _____ name & ANNUAL CONFIDENTIAL report IN respect OF OFFICERS (GAZETTED STAFF). FOR THE YEAR _____ Department/ Office_____ Part I 1. name of the Officer & Designation: 2. Date of birth: 3. Date of appointment in Health services : 4. Educational Qualification: 5. Present appointment: 6. Present scale of Pay: 7. Pay on the Ist April: (Other than casual leave)/training. Fellowship study leave during the year: Place of Posting Date: _____ Signature of the Officer: Part II Brief resume of the work done bay the officer reported upon during the period from _____ to _____ bringing out any special achievement of his/her during the period , not exceeding the hundred words (to be filled (to be filled by the officer reported upon) 2 name & 8.)

2 Assessment by Reporting Officer: Do you agree with the report of the work as indicating by the officer in Part-II if not, give reasons disagreeing with it: 9. State of Health: Note: Easements under following columns 6-20 should be expressed clearly by including work. 10. Temperament: a) Is he/she calm and does he/she retain poise at time of pressure of work. b) Does he/she got provoked easily: 11. Knowledge of Rules, Regulation & Procedures: a) Adequate b) Not good enough of Work: Attention to detail a) Reliable and comprehensive b) Considers all relevant details c) Inclined to be superficial: 13. Opinion Regarding Professional Ability: General Profession Knowledge a). Excellent: b). Very Good c). Good d) Average e). Poor 3 name & Special Knowledge or ability in any branch of professional work.

3 Is he/she keeping his/her professional knowledge upto date: Any contribution to scientific journals etc: (For Teaching and research staff only) Any research work done during the year:_____ Part-III 14. Ability of Analyses facts, propose alternatives and help in decision, and policy Making for administrators only col. 14 to 18). 15. Quality of Supervision: 1. Very through and of a high order: 2. Good and useful 3. Average and routine 4. Poor: 16. Initiative & Drive: a) Execellent b) In good measures c) Adequate: d) Lacking: 17. Readiness to Assume responsibility a) Promptly comes forwarded accepts responsibility, if comes. b) Accepts responsibility, if comes: c) Tends to evade: d) Passes responsibility to others. 18. Controls and Management of Staff: i) Ability to inspire confidence and to get the best out of the staff a) Get the best from them: b) Just manages: c) Inadequate: 4 name & ii) Quick capacity to train, help & advice the staff and ability to handle his/her subordinate: a) Excellent: b) Very Good: c) Good: d) Average: 19.

4 Relationship With colleagues: a) Wins and retains the highest regard of all: b) Is generally liked and respected: c) Not easy in his/her relationship but gerts by: d) A difficult colleagues: 20. Relationship with Public/Patients: a) Wins and retains the highest regard of all: b) Is generally liked and respected: c) Not easy in his/her relationship but gets by 21. Contribution towards: a) National Family Welfare Programme: b) Public Health Programme: 22. Altitude towards Scheduled Caste/Scheduled Tribe/Weaker Sections of society. Please comment on the officer s Understanding and response of the problems of Scheduled Castes and ST and his/her efforts to deal with them 5 name & 23. Integrity: Grading:_____ Signature of reporting Officer:_____ name in Block Letters: _____ Designation_____ name & Sig:_____ Part-IV 23.

5 Remarks of reviewing Officer: a) Length of service under the reviewing Officer: _____ c) Do you agree with the Reporting Officer in regard to his remarks on the resume of the work done by the Officer no contained in Part-II of the report ? If not, indicate briefly the reason for disagreeing with reporting officer and the extent of your disagreement:_____ _____ d) Overall assessment of performance and qualities: _____ _____ ____ e) Has the Officer and special characteristic are abilities which would justify his advancement and special selection for higher appointment out of turn if so, mention these characteristics briefly and indicate why you consider his/her fit for out of turn promotion: _____ _____. 24. Grading_____ Signature of Reviewing Officer:_____ name in block Letter_____ Designation:_____ 6 name & Part- V Counter signature by the next higher authority with remarks if any Signature of counter signing officer:_____ name in block Letters_____ Designation:_____ 7 name & History sheet name : (To be filled by the Officer) 1.

6 name in (Full) _____ 2. Father s name : _____ 3. Date of birth: _____ 4. Place of Birth: _____ 5. Home Village/town Address: _____ _____ _____ 6. Whether belonged to Scheduled _____ Cast/Scheduled tribes If so (exact Cast of Tribe to be specified). 7. Educational Qualifications: Degree of Examination passed University Year Division Distinction obtain if any Signature Designation 8 himachal pradesh services ANNUAL CONFIDENTIAL report in respect of Non-Gezatted Staff (Clerical Staff). For the year Ist April _ to 31st March 1. Department/ Office 2. name & Designation: Date of birth: 4. Date of appointment in Health services : 5.

7 Present appointment: & Pay Scale: 6. Section/ Deptt. in which employed during the year: ASSESSMENT BY REPORTING OFFICER 7. Is he/she efficient generally if not, have his/her defects been pointed out to him: 8. what is your opinion about his/her character and conduct: 9. Is his/her habits temperate and he/she trustworthy: 10. If Head clerk/Supdt, has he/she maintained Discipline and good order in the office. 11. Further remarks as to character ability, handwriting and whether he/she can note and draft efficiently: 12. Has he/she has a good reputation for honesty in his/her present post: 13 .Grading: Outstanding/very good/Good/Fair/Poor. Signature of Reporting Officer With Seal: Remarks by the Reviewing Officer: Reviewing Officer 9 himachal pradesh services ANNUAL CONFIDENTIAL report in respect of Non-Gezatted Staff (Para Medical Staff).

8 For the year 1. Department/ Office 2. name & Designation: 3. Date of birth: 4. Date of appointment in Health services : 5. Present appointment: & Pay Scale: 6. Study leave during the year: 7. Place of posting: 8. Training & Fellowship: ASSESSMENT BY REPORTING OFFICER 9. General character: 10. Physical fitness for duties: 11. Professional Knowledge: 12. her/his retention in service desirable: 13. General Remarks: 14. Integrity: 15. Grading: Outstanding, very good, good, fair, Poor Signature of Reporting Officer: With seal: Remarks by the Review Officer: Signature.