Caregiver Performance Evaluation Form
Caregiver's Name
First Name
Last Name
Supervisor's Name
First Name
Last Name
Evaluation Date
-
Month
-
Day
Year
Date
Evaluation
Dependability
1
2
3
4
5
Client Focus
1
2
3
4
5
Decision Making
1
2
3
4
5
Communication
1
2
3
4
5
Taking Initiative
1
2
3
4
5
Ongoing Learning
1
2
3
4
5
Commitment
1
2
3
4
5
Excellence
1
2
3
4
5
Positive Attitude
1
2
3
4
5
Likeability
1
2
3
4
5
Adaptability
1
2
3
4
5
Comments/Examples
Performance Indicators
Rate the caregiver according to the following performance indicators.
Exceeds Expectations
Meets Expectations
Needs Improvement
Attendance
Punctuality
Meeting Attendance
Attending Trainings
Emergency Shift Acceptance
Client Compliments
Client Complaints
Job Knowledge
Overall Rating
Exceeds Expectations
Meets Expectations
Needs Improvement
Overall Comments
Supervisor Signature
Clear
Submit
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