Surgical Technician Performance Evaluation Form
Evaluate the operational job performance of a surgical technician in a clinical workplace setting.
Technician's Full Name
*
First Name
Last Name
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Punctuality and Attendance
*
1
2
3
4
5
Adherence to Sterile Techniques
*
1
2
3
4
5
Technical Skills Assessment
*
Rows
Excellent
Good
Satisfactory
Needs Improvement
Instrument Preparation
1
2
3
4
Assisting During Surgery
5
6
7
8
Equipment Handling
9
10
11
12
Room Turnover
13
14
15
16
Teamwork and Communication
*
Consistently collaborates and communicates effectively
Usually works well with team
Occasionally has communication issues
Frequently experiences teamwork challenges
Areas of Strength (Select all that apply)
Attention to Detail
Calm Under Pressure
Adaptability
Leadership in the OR
Effective Communication
Other
Areas for Improvement (Select all that apply)
Time Management
Instrument Handling
Following Protocols
Communication with Team
Adaptability
Other
Professionalism and Attitude
*
Always professional and positive
Usually maintains professionalism
Occasionally unprofessional behavior
Needs improvement in attitude
Evaluator's Additional Comments
Submit Evaluation
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