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Home
Apply
Job Search
Staff
Clients
About Us
Contact Us
Resources
Employee Portal User Guides
Timekeeping Instructions & Timesheets
View Your Pay Stubs
Reference & Evaluation Forms
Submit a Reference or Evaluation
Refer a Friend
Incident Report Form
Submit an Incident Report
Sample Resume
Search Contract Jobs
Search Per Diem Jobs
Lifeline Employee FAQ
Travel Nursing & Pay FAQ
The Joint Commission
Education Resources
Customer Feedback Form
Log In
Clinical Performance Review
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Clinical Performance Review
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Please use the following criteria in providing professional feedback for the individual named below. Your time and comments are very much appreciated. We strive to maintain the highest standards of HR practice by diligently screening candidates who meet and/or exceed the requirements mandated by The Joint Commission for Health Care Staffing.
NURSE MANAGER / CHARGE NURSE / CLINICAL SUPERVISOR - Please complete the following:
Evaluator's Name
*
Evaluator's Title
*
Name of Facility / Hospital
*
Unit / Setting
*
Email
*
Phone Number
*
Name of Healthcare Professional (HCP) for whom you are providing feedback:
*
Date(s) you supervised this HCP (mm/yyyy – mm/yyyy)
*
Was this HCP Agency or Staff?
*
Was this HCP Part Time, Full Time, PRN, or Contract?
*
Rank the Professional Behaviors: Clinical Competence and Judgement
*
Exceeds Standards
Meets Standards
Needs Improvement
Rank the Professional Behaviors: Flexibility & Adaptability
*
Exceeds Standards
Meets Standards
Needs Improvement
Rank the Professional Behaviors: Communication Skills
*
Exceeds Standards
Meets Standards
Needs Improvement
Rank the Professional Behaviors: Time Management Skills
*
Exceeds Standards
Meets Standards
Needs Improvement
Rank the Professional Behaviors: Utilization of Electronic Medical Records (EMR)
*
Exceeds Standards
Meets Standards
Needs Improvement
Rank the Professional Behaviors: Attitude & Cooperation
*
Exceeds Standards
Meets Standards
Needs Improvement
Rank the Professional Behaviors: Attendance & Punctuality
*
Exceeds Standards
Meets Standards
Needs Improvement
Is this HCP eligible to return to your facility / hospital?
*
Yes
No
Unable to Comment
Please provide any additional comments about this HCP
Date Completed
*
Submit
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