Nursing Colleague Feedback Survey Form
Please provide constructive feedback about your nursing colleague’s workplace performance, teamwork, communication, professionalism, and support.
Your relationship to the colleague
*
Direct coworker
Supervisor
Subordinate
Other
Colleague’s first name or initials
*
Workplace performance
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Teamwork
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Communication skills
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Professionalism
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Supportiveness
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
How often do you interact with this colleague?
*
Daily
Several times a week
Weekly
Rarely
Would you recommend this colleague for future team projects?
*
Yes
No
Not sure
Please share any specific examples or comments about this colleague’s strengths.
Suggestions for improvement (optional)
Submit Feedback
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