Healthcare Staff Employment Review Form
Please complete this form to review and assess the employment performance of a healthcare staff member.
Staff Full Name
*
First Name
Last Name
Position/Job Title
*
Department/Unit
*
Supervisor/Reviewer Name
*
First Name
Last Name
Review Period (e.g., Jan 2025 - Dec 2025)
*
Overall Performance Rating
*
1
2
3
4
5
Please rate the staff member on the following competencies:
*
Rows
Excellent
Good
Satisfactory
Needs Improvement
Patient Care Skills
1
2
3
4
Medical Knowledge
5
6
7
8
Communication Skills
9
10
11
12
Teamwork
13
14
15
16
Reliability & Punctuality
17
18
19
20
Professional Conduct
*
Consistently professional
Occasionally unprofessional behavior observed
Unprofessional conduct observed and documented
Attendance Record
*
Excellent attendance
Occasional absences/tardiness
Frequent absences/tardiness
Which areas require further improvement? (Select all that apply)
Patient Care
Technical Skills
Communication
Teamwork
Punctuality
Other
Additional Comments or Recommendations
Submit Review
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