Transmission Record Following is to be normally filled in by the Appraisee[ ] failing which by Reporting Authority[ ] / Establishment Branch [ ]. Tick[v]which ever is applicable Financial Year:____________________ For the period.* from _ _/ _ _/ _ _ _ _ to _ _/ _ _/ _ _ _ _ Full Name of the Officer : Date of Birth: - - Service to which the officer belongs: Group (A/B) to which the officer belongs: Designation during the period : Office to which posted: Head Quarters: Details of Transmission / Movement of PAR (The relevant portion will be filled in at the time of transmission of PAR by respective transmitting staff.) Transmission at the Appraisee level. Name of the Appraisee Designation during the period of report. Current Designation & Address (at the time of transmission of the PAR) Letter No./U.O.I. No. & / or Date by which PAR was transmitted to the Reporting Authority/office. Name Current designation & address of the Reporting Authority/office to whom PAR was transmitted. Name & designation of appraisee/staff transmitting the PAR (If given directly by appraisee write "SELF") Signature of the appraisee/staff transmitting the PAR Transmission at the Reporting Authority level[(i)First Reporting Authority/(ii)Second Reporting Authority(if any)] Name of the Reporting Authority (i) (ii) Designation during the period of report. (i) (ii) Current Designation & Address(at the time of transmission of the PAR) (i) (ii) Letter No. & Date by which PAR was transmitted to the Reviewing Authority/office. (i) (ii) Name Current designation & address of the Reviewing Authority/office to whom PAR was transmitted. (i) (ii) Name & designation of staff transmitting PAR (i) (ii) Signature of the staff transmitting PAR (i) (ii) Transmission at the Reviewing Authority level [(i)First Reviewing Authority/(ii) Second Reviewing Authority (if any)] Name of the Reviewing Authority (i) (ii) Designation during the period of report. (i) (ii) Current Designation & Address(at the time of transmission of the PAR) (i) (ii) Letter No. & Date by which PAR was transmitted to the Accepting Authority/office. (i) (ii) Name Current designation & address of the Accepting Authority/office to whom PAR was transmitted (i) (ii) Name & designation of staff transmitting PAR (i) (ii) Signature of the staff transmitting PAR (i) (ii) Transmission at the Accepting Authority level Name of the Accepting Authority Designation during the period of report. Current Designation & Address(at the time of transmission of the PAR) Letter No. & Date by whcih PAR was transmitted to the PAR Branch. Office to which PAR was transmitted. Name & designation of staff transmitting PAR Signature of the staff transmitting PAR 1/8 *Appraisee will submit his Self Assessment for the period separately for each Reporting Authority during the financial year. Performance Appraisal Report (PAR) for Group A & B Officers of the Government of Orissa 2/8 PERFORMANCE APPRAISAL REPORT PART-I PERSONAL DATA (To be filled in normally by the Appraisee [ ]/failing which by Reporting Authority[ ] / Establishment branch[ ]. Tick[v ] which ever is applicable.) Financial Year : __________ for the period *from : _ _ /_ _ / _ _ _ _ to _ _ / _ _ / _ _ _ _ 1.Full Name of the Officer: 2. Date of Birth: - - 3. Service to which the Officer belongs: 4. Group to which the Officer belongs(A or B): 5. Designation during the period of Report: 6. Office to which posted: 7. Head Quarters: 8. Period(s) of absence (on leave, training etc., if 30 days or more). Please mention date(s). : PART-II ( Self-Appraisal to be filled in by the Appraisee) 1. Brief description of duties including the duties performed while in the additional charge of post(s).(Primary duties of the job in less than 100 words) *Appraisee will submit his Self Assessment for the period separately for each Reporting Authority during the financial year. 3/8 2. Please specify the important physical/financial/qualitative targets set for yourself or that set for you and your achievement against each target. For important tasks without any set targets, a brief description of the work performed may be also given. (Please write only in the space provided, no extra sheets are to be attached.) SI.No Task Target Achievement % of Achievement 3. Please indicate your special contributions, if any. (e.g. challenging tasks or major systemic improvements.) 4. What are the factors, if any, that hindered your performance ? Signature of Appraisee: Place: Date: - - 4/8 PART-III REMARKS OF THE REPORTING AUTHORITY From To 1. Length of service under the Reporting Authority - -/ - -/ - - - - - -/ - -/ - - - - 2. Assessment of work output, attributes & functional competencies. (This should be on a relative scale of 1-5, with 1 referring to the lowest level & 5 to the highest level. Please indicate your rating for the officer against each item.) Item Description Rating Item Description Rating A Work Output 9. Ability to plan and organise his work 1. Quantity of Work Output 10. Ability to work in a team 2. Quality of Output 11. Inter-personal skills B Personal Attributes 12. Oral communication skills 3 Sense of Responsibility 13. Written communication skills 4. Overall bearing and personality 14. Citizen focus 5. Innovativeness 15. Leadership Qualities 6. Decisiveness C Functional Competencies 7. Willingness to learn 16. Subject/Sector specific knowledge 8. Ability to motivate and develop subordinates 17. IT skills and competency 18. Analytical ability 3. (A) Pen Picture or General Assessment of the appraisee ( not more than 100 words). 3. (B) Inadequacies, deficiencies or shortcomings including on integrity, if any (Remarks to be treated as adverse). Mention specific supporting facts. 4. Attitude towards ST/SC and weaker sections: 5. Integrity(If integrity is doubtful or adverse, please write "Not Certified" in the space below and justify your remarks in box 3-B) 6. Overall Grading (Please sign in appropriate box) Outstanding Very Good Good Average Below Average* (Grade-5) (Grade-4) (Grade-3) (Grade-2) (Grade-1) For Overall Grading "Below Average", please provide justification in the Adverse box at Section 3(B) given above. For overall grading "Outstanding" please provide justification in the space below. Signature: Name of Reporting Authority: Designation during the period under report: Designation at the time of recording of remarks: Place: Date: - - 5/8 APPRAISAL 6/8 * "Below Average" grading will be treated as adverse and should be justified at Section 3(B). PART-IV REMARKS OF THE REVIEWING AUTHORITY Period under Reviewing Authority :- From to 1. Indicate if you agree with the assessment made by the Reporting Authority in Section 3 A of Part-III and give your general assessment. 2. Do you agree/partially agree/disagree with adverse remarks if any, given by the Reporting Authority in Section 3B of Part III? Give your remarks on inadequacies,deficiencies or shortcomings including on integrity if any (Remarks to be treated as adverse). Mention specific supporting facts. 3. Overall Grading (Please sign in appropriate box) Outstanding Very Good Good Average Below Average* (Grade-5) (Grade-4) (Grade-3) (Grade-2) (Grade-1) For Overall Grading "Below Average", please provide justification in the Adverse box in Part-IV, Section -2 above. For overall grading "Outstanding", please provide justification in the space below. Signature: Name of Reviewing Authority : Designation during the period under report: Designation at the time of recording of remarks: Place : Date: - - --/--/---- 7/8 --/--/---- to * "Below Average" grading will be treated as adverse and should be justified in Part-IV, Section 2, if Reporting Authority has not already justified in Section 3(B) of Part III. PART-V REMARKS OF THE ACCEPTING AUTHORITY Signature: Name of Accepting Authority : Designation during the period under report: Designation at the time of recording of remarks: Place: Date: - - FOR OFFICE USE BY THE PAR BRANCH [for review as well as other certificates/remarks] 8/8
