EMPLOYEE PERFORMANCE SELF-EVALUATION

My personal goal as a (hospital) employee is:

I believe my accomplishments in this evaluation period are:

I believe (hospital)'s goals are:

I believe (hospital) can improve by:

I can personally help (hospital) improve by:

PLEASE RATE YOURSELF ON THE FOLLOWING USING THIS GUIDE:

Excellent. All basic requirements in this section mastered. Exceeds expectations in most areas; requires minimal supervision.
Above Average. Basic job requirements performed satisfactorily; requires normal supervision and encouragement.
Average. Has not achieved all requirements in this section; requires more than the normal amount of supervision.
Improvement Needed.
Unsatisfactory. Many requirements have not been achieved; needs unusually high level of supervision.

AFTER RATING YOURSELF ON THE FOLLOWING SECTIONS, PLEASE EXPLAIN YOUR ANSWER (use back of sheet if needed)
AVAILABILITY (attendance, promptness, availability for relief and holiday shifts, willing to come in when called): _____________________________________________________________________________________________ _____________________________________________________________________________________________
APPEARANCE (neatness and professionalism): _____________________________________________________________________________________________
INITIATIVE (is able to recognize a problem and tries to solve it, recognizes a task and performs it, contributes and implements ideas): _______________________________________________________________________________ _____________________________________________________________________________________________
JUDGMENT (consistently has ability to pick the best option when a situation has multiple solutions): _____________________________________________________________________________________________ _____________________________________________________________________________________________
LEADERSHIP (communicates objectives, motivates others, promotes teamwork and maintains morale. Demonstrates "take charge" capabilities. Takes an active role in staff meetings): _____________________________________________________________________________________________ _____________________________________________________________________________________________
HOSPITAL POLICIES (knows, understands, and follows the established policies which govern the normal operation of the hospital): ______________________________________________________________________________________ _____________________________________________________________________________________________
TECH/RECEPTIONIST SKILLS (able to perform procedures as directed by a doctor; knows when to ask for assistance; knows how to use and maintain hospital equipment): _____________________________________________________________________________________________ _____________________________________________________________________________________________
PATIENT CARE (demonstrates humane treatment with compassion and concern for the well-being of the patients, provides diligent care): ___________________________________________________________________________________ ______________________________________________________________________________________________
CLINIC CLEANLINESS (keeps up with daily cleaning, completes chores as assigned, cleans up after him/herself, takes personal responsibility for clinic appearance) ______________________________________________________________________________________________ ______________________________________________________________________________________________
CLIENT SERVICE/COMMUNICATIONS (actively listens and is able to express thoughts clearly so client understands recommendations and estimates for the patients. Expresses empathy and compassion.): ______________________________________________________________________________________________ ______________________________________________________________________________________________
BUSINESS PROCEDURES (able to complete records and associated client forms in a timely and accurate manner. Understands computer operations.): ______________________________________________________________________________________________ ______________________________________________________________________________________________
INTRA-STAFF RELATIONS (promotes a cooperative working environment. Understands the value of teamwork and shows an enthusiasm and willingness to help the hospital function as a unit. Encourages and assists new staff members): ______________________________________________________________________________________________ ______________________________________________________________________________________________
PROFESSIONAL GROWTH (maintains currency in professional literature; attends local, state, and/or national CE meetings, keeps up to date on current procedures.): ______________________________________________________________________________________________
TROUBLESHOOTING (has the ability to deal with problematic situations): ______________________________________________________________________________________________ ______________________________________________________________________________________________
FOLLOW THROUGH (completes tasks assigned; takes personal responsibility for seeing all steps and phases of a case or project followed through; makes sure client receives discharge instructions, medications; sends personal belongings, etc): _____________________________________________________________________________________________ _____________________________________________________________________________________________

After completing this evaluation,
I believe the areas which need improvement are:

The reason I "ROCK" as an employee is:

EMPLOYEE'S SIGNATURE___________________________DATE__________

MANAGER'S SIGNATURE___________________________DATE__________