Infection Control Nurse Interview Evaluation Form
Evaluate infection control nurse candidates on core competencies, clinical knowledge, and interview performance.
Candidate Full Name
*
First Name
Last Name
Date of Interview
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluator Name
*
First Name
Last Name
Interview Context
*
Initial Screening
Final Interview
Panel Interview
Other
Role-Specific Competencies
*
Rows
Poor
Fair
Good
Excellent
Knowledge of infection control guidelines
1
2
3
4
Ability to identify and manage infection risks
5
6
7
8
Experience with outbreak investigation
9
10
11
12
Familiarity with regulatory compliance
13
14
15
16
Clinical Knowledge Assessment
*
1
2
3
4
5
Infection Control Practices
*
Rows
Needs Improvement
Meets Expectations
Exceeds Expectations
Hand hygiene compliance
17
18
19
Use of personal protective equipment
20
21
22
Environmental cleaning knowledge
23
24
25
Communication Skills
*
1
2
3
4
5
Prioritization & Scenario Handling
*
Demonstrates strong prioritization and decision-making
Adequate prioritization with minor gaps
Needs improvement in scenario handling
Overall Recommendation
*
Highly Recommend
Recommend
Recommend with Reservations
Do Not Recommend
Submit Evaluation
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