Candidate name *
Date of employment *
Facility *
Department *
Title
DR
MISS
MR
MRS
MS
Your name *
Last Name *
Email Address *
Your position *
How long did you work with the candidate? *
Please provide feedback based on your experience with the candidate. You should have worked at least one ten hour shift with the candidate before providing an evaluation. If you did not have the opportunity to observe the candidate for any given area, please indicate so.
Clinical - Knowledge base. Demonstrates adequate knowledge of basic and clinical sciences
-- Please select --
Requires further development
Consistent with level of appoinment
Performance better than expected
Performance exceptional
N/A or Not observed
Clinical judgement/decision making skills. Applies knowledge base and clinical findings in organising, synthetising and acting on information.
-- Please select --
Requires further development
Consistent with level of appoinment
Performance better than expected
Performance exceptional
N/A or Not observed
Emergency skills. Acts effectively, and when appropriate acknowledges own limitations and seeks help.
-- Please select --
Requires further development
Consistent with level of appoinment
Performance better than expected
Performance exceptional
N/A or Not observed
Procedural skills. Performs procedures competently.
-- Please select --
Requires further development
Consistent with level of appoinment
Performance better than expected
Performance exceptional
N/A or Not observed
Patient and Family. Interacts effectively and sensitively with patients and families/care givers.
-- Please select --
Requires further development
Consistent with level of appoinment
Performance better than expected
Performance exceptional
N/A or Not observed
Medical Records/Clinical Documentation. Provides clear, comprehensive and accurate records.
-- Please select --
Requires further development
Consistent with level of appoinment
Performance better than expected
Performance exceptional
N/A or Not observed
Professional Responsibility. Demonstrates, appropriate attitudes and behaviours, including punctuality, reliability, honesty and professional appearance.
-- Please select --
Requires further development
Consistent with level of appoinment
Performance better than expected
Performance exceptional
N/A or Not observed
Time management skills. Organises and prioritises tasks to be undertaken.
-- Please select --
Requires further development
Consistent with level of appoinment
Performance better than expected
Performance exceptional
N/A or Not observed
Please give specific examples of where this candidate could have PERFORMED BETTER
Please give specific examples of where this candidate EXCEEDED EXPECTATIONS
Would you accept this candidate in your department again?
-- Please select --
Absolutely
Yes, with some hesitation
No
Would you recommend this candidate to another department?
-- Please select --
Yes
No
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