Lontra HR · Working template
Employee self-assessment evidence worksheet
Collect real examples and turn them into a contribution, challenge and development discussion.
Use this worksheet with a fictional example first, then adapt it to your organization’s process. Keep personal or confidential information in your authorized systems.
- Replace the fictional rows with examples from your own review period.
- Keep personal contribution and team outcome distinct in the relevant fields.
- Use permitted references and identify uncertain effects clearly.
- Select a short set of paragraphs for the review and bring the remaining questions to the discussion.
Click a cell to edit it locally. Print or save as PDF to keep your completed copy. Changes are not sent to a server.
| Account | Situation and date | My action | Observation or permitted source | Next question or support |
|---|---|---|---|---|
| Fictional worked achievement | Supplier launch preparation | Maintained checklist and added ownership fields | Final handover checklist | Did the owners find open work clearer? |
| Fictional worked challenge | Draft guide dependency | Continued editing before raising the approval gap | Draft and practice-session dates | Agree an earlier dependency checkpoint |
| Fictional worked development | Readiness meeting | Moved on before an owner confirmed an action | Meeting notes and own account | Lead a future section with observation |
| My contribution | [Task and date] | [What I did] | [What happened and how it can be checked] | [Feedback to ask for] |
| My shared achievement | [Team task and date] | [My contribution and others’ roles] | [Shared result and limits] | [What I want to understand] |
| My challenge | [What was difficult] | [What I tried] | [What I observed] | [What I would change or need] |
| My development priority | [Situation I want to handle better] | [Behavior to practice] | [Example to discuss] | [Opportunity and support to request] |
Prepared by Lontra HR Editorial · 10 November 2026 · Editorial review copy. Filled examples, where present, are fictional and demonstrate the method.