Form Phs 838 – Fill Out and Use This PDF

SECTION 1. ADMINISTRATIVE DATA: Required.

PART I. OFFICER ADMINISTRATIVE INFORMATION.

a. Name and Rank of Rated Officer (Last, First, MI, Rank):

b. Period Covered by Report

(MM/DD/YY):

From ______________________

To ______________________

c. Type of Report

(Check only one):

Annual

Officer Transfer

Supervisor Transfer

Interim

Other ______________________

d. HHS Division or Non-HHS Organization for Report Period:

e. Position/Billet Title for Report Period:

f. Position/Billet Grade for Report Period (check highest):

g. In current billet since (MM/DD/YY):

O - 1 O - 2

O - 3 O - 4

O - 5 O - 6

O - 7 O - 8

__________________________

PART II. RATER’S COMMENTS AND SIGNATURE.

a. Name and Job Title of Rater (Last, First, MI, Title):

b. Phone Number:

c. Time supervising this officer

______ Years ______ Months

d. Please rate the officer’s overall performance of job duties during the report period.

Satisfactory

Marginal

Unsatisfactory

e. Strengths: List the areas in which the officer displays strong qualities and superior skills. (3 lines = 240 Courier New 10 pt. characters)

f. Areas for Improvement: List the areas needed for continued growth and development. (3 lines = 240 Courier New 10 pt. characters)

g. Signature / Date

_____________________________________________________________________

___________________

PART III. RATED OFFICER’S SIGNATURE and CONCURRENCE / NON-CONCURRENCE.

a. Select one option.

I concur with this rater's evaluation.

I disagree with this evaluation and reserve the right to file a rebuttal.

b. Signature / Date

I have read this review and have had the opportunity to discuss it.

_____________________________________________________________________

___________________

PART IV. REVIEWING OFFICIAL’S COMMENTS, SIGNATURE AND CONCURRENCE / NON-CONCURRENCE.

a. Name and Job Title of Reviewing Official (Last, First, MI, Title):

b. Phone Number:

c. Select one option.

I concur with this evaluation.

Although this evaluation is reasonable, this rater is somewhat more demanding than average.

Although this evaluation is reasonable, this rater is somewhat less demanding than average.

I disagree with this evaluation.

d. Reviewing Official’s Comments.

e. Signature / Date

__________________________________________________________________

_________________

f. Agency Liaison / Date

__________________________________________________________________

_________________

PHS-838 (Rev. 07/2010)

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PHS-838 (Rev. 07/2010)

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- Demonstrates behavior that

- Demonstrates behavior that facilitates

- Consistently demonstrates behavior that

maintains the status quo, often

collaboration, fairness, and inclusiveness.

contributes to the organization’s success by

seeking direction in accomplishing

- Influences others through actions,

fostering effective relationships, inspiring

the

the team’s goals.

accomplishments, and team work.

trust of others, and nurturing group

- Has minimal influence on others.

effectiveness and cohesion.

- Influences others by exhibiting vision,

innovation, resilience, inclusiveness, and by

teaching and coaching others.

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- Needs assistance in identifying

- Recognizes opportunities for growth and

- Independently seeks out and completes

opportunities to improve work

seeks experiences to improve work

challenging opportunities that broaden

performance.

performance.

expertise, maximize job performance, and

- Work performance improves with

- Willingly incorporates new approaches

enhance value to the program.

regular supervisory input and

and responsibilities to advance program

- Anticipates program needs including

goals. Requires minimal supervision and

potential barriers. Proactively and decisively

detailed instructions about

seeks guidance with solutions only for

implements innovative solutions

to improve

assignments.

unexpected barriers.

work processes with impact beyond scope

- Needs guidance to understand how

- Accepts responsibility for personal

of assigned responsibilities.

personal decisions and actions

decisions or mistakes and learns from

- Actively identifies personal role in a

contribute to mistakes or impedes

errors.

problem and contributes to the solution,

success of individual and group

enhancing the successful outcome of

projects.

individual and group projects.

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- Needs assistance in expressing

- Tailors communication (verbal and

- Organizes and expresses complex ideas,

main thoughts clearly, both orally

written) to the level and experience of the

both orally and in writing, to successfully

and in writing, and clarifying the

audience, ensuring that messages are

inform and influence individual and

meaning and intent of others'

organized, useful and accurate.

managerial decisions that advance the

communication.

- Utilizes strong listening skills to formulate

organization’s mission.

- Uses correct spelling, grammar,

direct, responsive answers to questions.

- Is a confident and effective speaker, asks

open-ended questions, and recognizes and

and punctuation to create simple

accommodates a vast diversity of ideas and

documents.

traditions.

4.

Interpersonal Skills - Facilitates relationships in a manner that motivates others to maximize their abilities, skills, and knowledge to affect the desired

outcomes.

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- Prefers work activities that can be

- Participates in group activities,

- Promotes collaboration by demonstrating

completed independently and does

demonstrates respect for others, and

respect, friendliness, appreciation, humor,

not require sustained interaction with

receives and offers constructive feedback,

empathy, and a positive attitude. Serves as

individuals of differing viewpoints or

which contributes to the achievement of

a mentor to others.

opinions.

organizational goals.

- Is cognizant of the needs of others and

- Minimally contributes to the

- Contributes to the resolution of conflicts.

works to ensure equal treatment of all

within

resolution of conflicts or

the work environment. Serves as mediator in

disagreements.

resolving conflicts.

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- In collaboration with supervisor, sets

- Determines individual work priorities

- Optimizes time and resources efficiently, and

and acts on priorities for work activities

based on organizational needs and

anticipates unexpected situations in order to

which usually results in meeting

acts on those priorities with minimal

attain the highest quality work.

predetermined deadlines.

supervisory guidance; completes

- Clearly and independently recognizes how the

- Seeks assistance in managing

assignments on time.

work of the individual relates to work of others

multiple work assignments and in

- Sets realistic deadlines, based on

within and outside the organization;

understands

identifying priority assignments.

sound criteria; keeps supervisor and

the purpose of the work; and establishes

others informed of progress of

realistic priorities and deadlines.

activities.

- Develops project or work plans that set clear,

- Met written performance goals for

well-defined desired outcomes and establishes

last year as agreed upon with

methods of measuring progress, resulting in the

supervisor.

advancement of the organization’s mission.

6. Professional Competencies - Demonstrates knowledge, skills, and abilities to function successfully in the position.

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- Basic knowledge of subject matter

- Demonstrates in depth knowledge

- Exhibits great depth and breadth of knowledge

required for assigned duties;

of subjects required by assigned

of multiple subjects; is viewed by others within

demonstrates average ability to learn

duties; is viewed as a competent and

and outside immediate office as a subject

and apply specialized knowledge.

credible authority on specialty or

matter expert.

- Seeks assistance in understanding

operational issues.

- Excellent grasp of complex issues, concepts

and situations, and applies lessons learned to

issues, concepts, and situations which

- Clear understanding of issues,

concepts and situations and applies

improve individual and organizational

affect job performance.

lessons learned to improve individual

productivity.

- Needs supervisory assistance to

productivity.

- Consistently produces work of exceptional

ensure quality work products.

- Quality of work is commensurate

quality.

with Officer’s rank.

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- Needs guidance in analyzing facts,

- Employs sound judgment, logical

- Keen analytical insight and understanding of

alternatives, and impact before making

reasoning, and uses resources

key issues and relevant information to make

decisions.

wisely; makes timely and accurate

appropriate decisions; is sought after to resolve

- Majority of judgments are relevant and

decisions.

complex problems.

correct.

- Opinions sought by others.

- Consistent, superior judgment inspires the

confidence of others.

8. Overall Effectiveness - Synthesis of Officer’s performance, and impact on program in current position.

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- An adequately performing Officer with

- A very competent Officer making

- A distinguished Officer, recognized for

some potential to accept increased

significant contributions that enhance

expertise with impact extending beyond

responsibilities and for professional

the assigned position, respected by

assigned position; serves as a role model for

growth.

peers; good potential for continued

others in the program.

growth and development.

PHS-838 (Rev. 07/2010

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PHS-838 (Rev. 07/2010)

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PHS-838 (Rev. 07/2010)

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PHS-838 (Rev. 07/2010)

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