TRAINEE EVALUATION FORM
Trainer Name
Trainee Name
Date
Which shadowing shift is this for trainee?
Please Select
1
2
3
4
5
6
7
8
More
Choosing the correct template
Please Select
1
2
3
4
Removing greet time
Please Select
1
2
3
4
Completing HPI correctly
Please Select
1
2
3
4
Completing ROS (W/ phrase)
Please Select
1
2
3
4
Marking reviewed and none or all that apply on the risk factors
Please Select
1
2
3
4
Completing Past hx/Social hx
Please Select
1
2
3
4
Completing the exam correctly
Please Select
1
2
3
4
Communicating with the physician
Please Select
1
2
3
4
Spelling
Please Select
1
2
3
4
Adding scribe attestation
Please Select
1
2
3
4
Completing procedure notes
Please Select
1
2
3
4
Inputting Lab/Rad attestations
Please Select
1
2
3
4
Inputting EKG's/rhythm strip with phrase
Please Select
1
2
3
4
Putting in re-eval/progress notes
Please Select
1
2
3
4
Documenting admit/consult calls
Please Select
1
2
3
4
Inputting clinical impressions
Please Select
1
2
3
4
Signify dispo time and stamping it
Please Select
1
2
3
4
Do you feel like they are ready to be on their own yet?
Any other comments?
Submit
Should be Empty: