Staff Activity Form
January 2013

Work Period Jan.-Dec. 2012

This form should be filled out by you and given to your supervisor prior to the performance appraisal interview. Include activities/projects/points that you perceive to be important and that you wish your manager to take into consideration.

Would you like to have this form attached to your performance appraisal? Yes No

Department/School: Cheriton School of Computer Science

Name: Supervisor:

Employees Highlights

What were the challenges and/or accomplishments you experienced this year?





What challenges do you foresee or would you like to pursue in the coming year?





Working Environment

(suggested for discussion in the interview with your supervisor)

Do you have the tools and equipment (hardware, software, ergonomic workspace, etc.) required to do your job?





What Training and Development opportunities did you pursue this year and how did they complement your job? What Training and Development opportunities would you like to explore in the coming year?





How has your job changed in the past year, and how would you like to see it change in the future? Are you comfortable with your current workload?





What would you change about the way you communicate and interact with your supervisor?





Are there ways your supervisor can improve on providing constructive feedback to help you in the performance of your job duties?





Were you involved in any volunteer activities on campus outside the scope of your job duties? If so, what do you feel are the personal and professional benefits to you and/or the University?





Does your job description reflect what you do?





Are you aware of the general requirements and your responsibilities under UW Policy 34, the mandate of the Joint Health and Safety committee and the procedures to address health and safety concerns?





Do you have or are you aware of any health and safety concerns that have not been addressed?





Is there any health and safety related training you would be interested in attending?





What other issues would you like to discuss?






Employee's signature                                                                 Date


Supervisor's signature                                                               Date