Nursing Preceptor Evaluation Form
Please fill out this evaluation form to provide feedback on your preceptor experience.
Preceptor's Name
First Name
Last Name
Your Name
First Name
Last Name
Date of Evaluation
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall Evaluation of Preceptor
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Communication Skills
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Knowledge of Nursing Practice
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Availability and Support
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Ability to Provide Constructive Feedback
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Strengths of the Preceptor
Areas for Improvement
Would you recommend this preceptor to other students?
Yes
No
Additional Comments
Submit
Should be Empty: