Employee Evalution Form

MEDRelief Staffing

Employee Evalution Form

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Employee Evalution Form

1. As part of our Performance Improvement Program, we would appreciate your time in evaluating our employee’s performance.
2. Please complete the following Employee Evaluation
3.

Please click the

'Submit Evaluation’ button at the end of the form to send your info to us.

1 = Poor ... 2 = Needs Improvement ... 3 = Average ... 4 = Above Average ... 5 = Excellent

Employee Evaluation Form

Name:

Facility:

Date(s) Assigned: (Ex: mm/dd/yyyy)

Facility Supervisor/Evaluator:

Facility Supervisor/Evaluator Email:

Demonstrates a clinical proficiency for the assignment:

1

2

3

4

Ensures accuracy and completeness of work in appropriate timeframe:

1

2

3

4

Adheres to the policies and procedures of the facility. (HIPAA, National Patient Safety Goals, Infection Control, Risk Management:

1

2

3

4

Reports to work on time for assigned shift:

1

2

3

4

Complies with facility dress code and name tag is visible:

1

2

3

4

Maintains a professional attitude towards coworkers and patient:

1

2

3

4

Conducts daily activities with the appropriate ethical and legal guideline:

1

2

3

4

Thank you for submitting your Employee Evaluation.

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