Community Health Worker Interview Evaluation Form

Community Health Worker Interview Evaluation Form
Use this form to evaluate community health worker candidates during interviews. Please provide ratings and comments for each section.
Candidate Name
First NameLast Name
Interview Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Communication Skills

1
2
3
4
5
1 is Poor, 5 is Excellent
Knowledge of Community Health Topics

1
2
3
4
5
1 is Limited, 5 is Extensive
Professionalism and Attitude

1
2
3
4
5
1 is Needs Improvement, 5 is Outstanding
Ability to Engage with Community Members

1
2
3
4
5
1 is Weak, 5 is Strong
Problem-Solving Skills

1
2
3
4
5
1 is Limited, 5 is Excellent
Comments on Candidate's Strengths
Areas for Improvement
Overall Recommendation
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