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EMPLOYEE PERFORMANCE EVALUATION
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Name
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First
Last
Date
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Email
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Phone
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EVALUATION FORM
Employee Name
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First
Last
JOB TITLE:
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RN
LPN
QMA
CNA
Other
If Other: Job Title
DEPARTMENT:
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PERIOD OF EVALUATION FROM:
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PERIOD OF EVALUATION TO:
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TYPE OF EVALUATION:
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Initial 3-Month
Annual
Interim
RATING SCALE:
1. Needs Improvement – Performance and/or adherence to policy must improve to meet expectations of the position 2. Meets Expectations – Competently performs job duties; requires no more guidance, training or supervision than is typically required of people in this position 3. Exceeds expectations – Frequently performs at a level higher than the performance standard; accomplishments were made in areas other than the stated job duties
1. PERFORMANCE OF JOB DUTIES & COMPETENCIES
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Needs Improvement
Meets Expectations
Exceeds Expectations
Details:
2. Attendance
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Needs Improvement
Meets Expectations
Exceeds Expectations
Attends work regularly and is punctual. Personal time off and other leave is approved rather than unplanned.
Details:
3. Fosters a Positive Work Environment
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Needs Improvement
Meets Expectations
Exceeds Expectations
Treats co-workers, clients, suppliers, vendors, members of the public, and management with courtesy and respect; willingly completes assigned work and readily assists others in the performance of their duties.
Details:
4. Respects Diversity
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Needs Improvement
Meets Expectations
Exceeds Expectations
Treats clients and co-workers with dignity and does not discriminate against or harass clients or co-workers because of disability, race, color, gender, age, religion, ethnicity, citizenship status, sexual orientation, or sexual identity. Promptly reports use of inappropriate jokes, comments and racial, ethnic, gender or other slurs to management.
Details:
5. Maintains Confidentiality
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Needs Improvement
Meets Expectations
Exceeds Expectations
Follows HIPPA requirements as applicable to job duties; Maintains client confidentiality, only sharing information with those with a medical need to know. Maintains confidentiality of employee and donor information, as applicable to job duties.
Details:
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