Intern Shift Report
Please take a moment to fill out this report on the named Intern's performance this shift (to be filled out by SMS and Senior Registrars).
Name of Intern
*
Intern 1
Intern 2
Intern 3
Intern 4
Please select Intern from list
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
US format unfortunately!
Shift time
AM
PM
Night
AM/PM/Night
Clinical area
Main Department
Fast Track
Short Stay
Main, FT, SSU
Performance this shift
*
Rows
Excellent
Above expected
At expected
Below expected
Communication
1
2
3
4
Knowledge
5
6
7
8
Efficiency
9
10
11
12
Work ethic
13
14
15
16
Strengths this shift...
Areas to work on...
Shift supervisor’s name
(Consultant or Senior Registrar)
Submit Survey
Should be Empty: