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The first pages of the Self-Assessment Form template

Self-Assessment Form

Document template for Google Docs and Word

Make a copy in Google Docs
Price
Free
Style
Minimal
Difficulty
Beginner
Updated
October 31, 2026

Every page (7)

Overview

Most people write a self-review in the last hour before the deadline and list tasks instead of results. This self-assessment form walks an employee through the year in order: achievements backed by dates and numbers, the challenges that got in the way, the skills they used and built, the support they need, and the goals they will take into the next cycle.

The sample is a completed review for a senior dispatch coordinator at Amberley Logistics, with late deliveries falling from 9.1% to 5.2%, six new dispatchers trained and five goals scored against targets. Replace the review period, results, evidence, support requests and goals with your own, then bring the form to your review conversation.

Useful for

  • Preparing for an annual performance review with dated, measurable examples instead of general claims
  • Writing a mid-year check-in that records what went well, what blocked you and what you need from your manager
  • Giving a manager a clear request for training budget, tools or workload changes before pay and promotion talks

What's included

  • Cover page with the employee, role, manager, review period and meeting date
  • Achievements page: six results with owner, date and a month-by-month chart
  • Challenges page with a seven-year trend, causes of the problem and what made it hard
  • Skills page built around a workshop the employee led, with its agenda and preparation
  • Support page: an escalation path with response times, contacts and two specific requests
  • Goals page: five goals scored against targets, plus next-quarter initiatives with owners

How to use it

  1. 1

    Click Make a copy in Google Docs, then confirm on the Google page. The copy is saved to your own Google Drive.

  2. 2

    Set the review period, your name, role and manager on the cover, then replace the sample achievements with your own dated results.

  3. 3

    Add the evidence for each result, such as a report, a figure or a message, and name who can confirm it.

  4. 4

    Rewrite the challenges, support requests and goals so that each one has a number, an owner and a date.

  5. 5

    Delete the Make it yours guide page, then share the form with your manager before the review meeting.

What you need

Requirements

  • A Google account with access to Google Drive

Works with

  • Google Docs
  • Microsoft Word (download the .docx)

Questions

Is this self-assessment form free to use?

Yes. Make a copy in Google Docs and edit it for your own review. You only need a Google account, and you can share it with your manager.

Are the company and the people real?

No. Amberley Logistics, Dana Whitcombe, her colleagues and every figure are fictional and exist only to show what a strong self-assessment looks like.

How many examples should I include?

Aim for at least three dated examples with a result, covering the whole year and not only the last few weeks. This sample uses six.

  • #self-assessment
  • #performance-review
  • #employee-review
  • #self-evaluation
  • #annual-review
  • #hr
  • #google-docs

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