Home Health Nurse Interview Evaluation
Complete this form to evaluate a candidate's suitability for the role of a home health nurse.
Candidate Full Name
*
First Name
Last Name
Date of Interview
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluator Full Name
*
First Name
Last Name
Position Interviewed For
*
Relevant Nursing Experience (years)
*
Clinical Skills Assessment
*
Rows
Excellent
Good
Fair
Needs Improvement
Medication Administration
1
2
3
4
Wound Care
5
6
7
8
Patient Assessment
9
10
11
12
Documentation
13
14
15
16
Communication and Interpersonal Skills
*
1
2
3
4
5
Reliability and Professionalism
*
1
2
3
4
5
Adaptability to Home Settings
*
1
2
3
4
5
Briefly describe any strengths or concerns noted during the interview.
Overall Recommendation
*
Highly Recommend
Recommend
Recommend with Reservations
Do Not Recommend
Evaluator's Signature
*
Submit Evaluation
Submit Evaluation
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