UNITED REPUBLIC OF TANZANIA

OPEN PERFORMANCE REVIEW AND APPRAISAL FORM

(To be filled in Triplicate)
From: July . to June .
This Form replaces all other appraisal forms in the Public Service Institutions. It is intended to meet the reuirements of the
performance mana!ement system and development process.
NOTES ON HOW TO FILL THIS FORM:
". This Form must be filled by all employees in the Public Service Institutions. For principal officers and above# at the
end of the year# once fully completed# the ori!inal should be sent to the Permanent Secretary ($stablishments)#
duplicate to the respective %ead of or!anisation and triplicate to the public servant concerned. &ll other employees
(senior officers and belo') ori!inal copy should be sent to the (hief $)ecutive *fficer of the or!ani+ation# duplicate
to the parent ministry of the specific cadre and the triplicate to the public servant concerned.
,. -here appropriate# each bo) shall carry only one letter or fi!ure. .etters to be in capitals.
/. Personal0&!reed ob1ectives are derived from the *r!anisation2s 'or3 plan (Strate!ic plan# &nnual operatin! plans or
&ction plans) and are e)pected to be implemented in the current year.
4. Sections ,# / and 4 of this Form shall be filled by the &ppraisee in consultation 'ith the Supervisor and sections 567
in the presence of a third party if necessary.
5. Please note that appraisals that are rated as " are the best performers and appraisals rated as 5 are the 'orst
performers. These should be brou!ht to the attention of top mana!ement and usually to the attention of the (hief
$)ecutive *fficer of their respective *r!anisation.
SECTION 1: PERSONAL INFORMATION
8ote (ode (hec3 9umber
8ote :escription
Sub 8ote Present Station
Sub6vote description
M F
9ame in Full
Surname First name ;iddle name <ender
&cademic =ualification
:uty Post Substantive Post
:ate of First &ppointment :ate of &ppointment to present post
: : ; ; > > > > : : ; ; > > > >
Salary Scale
Period served under
Present Supervisor
:ate of ?irth
No..of : : ; ; > > > >
Terms of Service
DD= Day, MM= Month, YYYY= Year, F= Female, Male= Male
"


TFN 832
,
SECTION 2: PERFORMANCE AGREEMENT
To be filled by the Appraisee in consultation with the Superisor
2.1
S/N
2.2 Agreed O!e"#$%e& 2.' Agreed Per()r*+,"e
T+rge#&
2.- Agreed
Per()r*+,"e Cr$#er$+
2.. Agreed
Re&)/r"e&
,.7 &ppraisee ,.@ Supervisor
. .. ..
9ame (in capital letters) Si!ned 9ame (in capital letters) Si!ned
:ate.. :ate


/
SECTION ': MID01EAR REVIEW 2DECEMBER .............................................3
To be filled by the Appraissee in Consultation with the Supervisor
'.1 S/N '.2 Agreed O!e"#$%e&
2A& 4er Se"#$), 23
'.' Pr)gre&& T)5+rd&
T+rge#
'.- F+"#)r& A((e"#$,g
Per()r*+,"e


4
SECTION -: REVISED OB6ECTIVES 2$( +,73
-.1 S/N -.2 Agreed Re%$&ed
O!e"#$%e2&3
-.' Agreed
Per()r*+,"e T+rge#&
-.- Agreed Per()r*+,"e
Cr$#er$+
-.. Agreed
Re&)/r"e&
4.7 &ppraisee 4.@ Supervisor
. .. ..
9ame (in capital letters) Si!ned 9ame (in capital letters) Si!ned
:ate.. :ate
5
SECTION .: ANNUAL PERFORMANCE REVIEW 8 APPRAISAL 26UNE 9999993
To be filled by the Appraisee and the Superisor
..1
S/N
..2 Agreed O!e"#$%e2&3 ..' Pr)gre&& *+de ..- R+#ed M+r:
A440
r+$&ee
S/4er
%$&)r
Agreed
M+r:
O%er+;; Per()r*+,"e M+r:: This should reflect the oerall performance and
achieement of a!reed ob"ecties in Section #.
R+#$,g:
" A *utstandin! performance , A Performance above avera!e / A &vera!e performance
4 A Poor performance 5 A 8ery poor performance
7
SECTION <: ATTRIBUTES OF GOOD PERFORMANCE
To be filled by the Appraisee and the Supervisor
<.1
S/N
<.2 MAIN FACTORS <.' =UALIT1 ATTRIBUTE <.- RATED MAR>
&ppraisee Supervisor &!reed
;ar3
" -*BCI9<
B$.&TI*9S%IPS
&bility to 'or3 in team
&bility to !et on 'ith other staff
&bility to !ain respect from others
, (*;;D9I(&TI*9 &9:
.IST$9I9<
&bility to e)press in 'ritin!
&bility to e)press orally
&bility to listen and comprehend
&bility to train and develop subordinates
/ ;&9&<$;$9T &9:
.$&:$BS%IP
&bility to plan and or!ani+e
&bility to lead# motivate and resolve conflicts
&bility to initiate and innovate
4 P$BF*;&9($ I9
T$B;S *F =D&.IT>
&bility to deliver accurate and hi!h uality
output timely
&bility for resilience and persistence
5 P$BF*B;&9($ I9
T$B;S *F =D&9TIT>
&bility to meet demand
&bility to handle e)tra 'or3
7 B$SP*9SI?I.IT> &9:
JD:<$;$9T
&bility to accept and fulfil responsibility
&bility to ma3e ri!ht decisions
@ (DST*;$B F*(DS &bility to respond 'ell to the customer
E .*>&.T>
&bility to demonstrate follo'er ship s3ills
&bility to provide on!oin! support to
supervisor(s)
&bility to comply 'ith la'ful instructions of
supervisors
F I9T$<BIT>
&bility to devote 'or3in! time e)clusively to
'or3 related duties
&bility to provide uality services 'ithout
need for any inducements
&bility to apply 3no'led!e abilities to benefit
<overnment and not for personal !ains
O%er+;; Per()r*+,"e Se"#$), <
R+#$,g:
" A *utstandin! performance , A Performance above avera!e / A &vera!e performance
4 A Poor performance 5 A 8ery poor performance
@
SECTION ?: OVERALL PERFORMANCE 2AVERAGE OF SECTIONS . 8 <3
(*;;$9TS ?> &PPB&IS$$ (if any):
@@@@@@@@@@@@@@@@@@@@@@@@@@@@ @@@@@@@@@@@@@@@@@@@@@@@
N+*e )( A44r+$&ee S$g,+#/re
@@@@@@@@@@@@@@@@@@@@@@
D+#e
(*;;$9TS ?> *?S$B8$B (if any):
@@@@@@@@@@@@@@@@@@@@@@@@@@@@ @@@@@@@@@@@@@@@@@@@@@@@
N+*e )( O&er%er S$g,+#/re
@@@@@@@@@@@@@@@@@@@@@@
D+#e
(*;;$9TS ?> SDP$B8IS*B (if any):
@@@@@@@@@@@@@@@@@@@@@@@@@@@@ @@@@@@@@@@@@@@@@@@@@@@@
N+*e )( S/4er%$&)r S$g,+#/re
@@@@@@@@@@@@@@@@@@@@@@
D+#e
SECTION A: EMPLO1EE REWARDS/DEVELOPMENTAL MEASURES/SANCTIONS
The supervisor 'ill recommend the most appropriate re'ard# developmental measures or sanctions a!ainst the
appraisee in accordance to the level of a!reed performance tar!ets.