Healthcare Professional Performance Assessment Form
Please complete the Healthcare Professional Performance Assessment Form to evaluate key aspects of performance in a work setting.
Healthcare Professional’s Full Name
*
First Name
Last Name
Evaluator’s Full Name
*
First Name
Last Name
Role of Healthcare Professional
*
Please Select
Physician
Nurse
Therapist
Technician
Other
Rate the healthcare professional’s communication skills
*
1
2
3
4
5
Rate the healthcare professional’s teamwork and collaboration
*
1
2
3
4
5
Professionalism (e.g., punctuality, respect, demeanor)
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Clinical skills and knowledge
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Please indicate your level of agreement with the following statements
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Demonstrates empathy toward patients
1
2
3
4
5
Responds promptly to requests
6
7
8
9
10
Handles stressful situations professionally
11
12
13
14
15
Overall performance rating
*
1
2
3
4
5
Additional comments or feedback
Submit Assessment
Should be Empty: