ANNUAL EVALUATION - PN System

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EVALUATIONYear: ______Sample 1-855-PNSystemSample 1-855-PNSystemEMPLOYEE EVALUATION SHEET - PROBATION PERIOD / ANNUAL * (circle)Name of Employee: ________________________________________ _______________________________________D ate of Employment: _________________ Position/Title: ________________________________________ ________Immediate Supervisor: ________________________________________ _____________________________________EVA LUATIONITEM DiscussedExceptional SatisfactoryNon-SatisfactoryImprovement NeededPersonal appearance/ Code of conduct/ BehaviorPunctuality/Visits Frequency complianceAttitude to work /Attitude to other workers and staff Acknowledgment/ Contract-Agreement reviewedAttitude-Communication with patients/familyResponsibility, JOB DESCRIPTION Discussion in details,follow Physician Plan of Care, Updates as guidelinesInitiative/Duties/Abilities/QA -QI-PI/Agency Evaluationprogram participation/learning experienceMorals/Ethics/Courtesy/Conflic t of interestAbility to record relevant notes, delivery on time,documentation guidelines complianceAbility to communicate in legible, professional manner,participation in Case Conference, follow standardsprecautions, Infection control of professional procedures.

EMPLOYEE RESPONSE INPUT (Self Evaluation) (To improve our services to our patients we need your input and concern, please fil out the following form, and

  Annual, Evaluation, Annual evaluation