Clinician Performance Evaluation

Thank you for taking the time to participate in this evaluation. Your feedback is essential in helping us assess and support the clinical and interpersonal skills of our healthcare providers. Please answer the following questions based on your experience with the clinician.

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Clinician Name*
Consent
Documentation: Accurately documents treatment and plans
Documentation: Seeks support and coaching for challenges
Adaptability: Applies knowledge, skills, and the right attitude to implement individualized plans
Communication: Communicates effectively with the individual and interdisciplinary team
Competency: Complies with site policies and procedures
Safety/Emergency Protocol: Promotes safety and adheres to departmental policies and procedures
Initiative: Identifies problems and uses available resources to take appropriate action
Initiative: Inquires about site policy when indicated
Initiative: Keeps leader informed of any concerns with timely escalation
Professionalism: Is respectful of others' preferences, values, and needs
Professionalism: Functions as an advocate for the site, adheres to policies, maintains confidentiality
Quality of Work: Provides education and training based on each individual's needs and abilities
Quality of Work: Coordinates education and training with all disciplines involved in treatment and services:
Quality of Work: Demonstrates application of knowledge and skills necessary for the assignment
Reliability and Attendance: Demonstrates regular and punctual attendance
Reliability and Attendance: Follows site policy and procedure for absences
Teamwork/Cooperation: Works effectively with the interdisciplinary team
Feedback from Patients or Families: Have you received any feedback from patients or their families regarding this clinician's social interactions and bedside manner?
What age population(s) did the provider care for during this evaluation period? (Select all that apply)
Did you or will you share this evaluation with the provider?
Is the provider suitable to return?
Overall, how satisfied are you with this clinician's performance in providing both clinical care and social interactions?
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