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Float Team Evaluation

Thank you for giving us the opportunity to serve you. Please help us serve you better by taking a couple of minutes to tell us about the service that you have received. We appreciate your business and want to make sure we meet your expectations.
Practice Locations
1. Clinic Manager Information
This question requires a valid email address.
2. In order to provide feedback that can be used for professional development, please respond to ANY of the following questions as it applies to our team member’s performance.

(*Note: It is not required that you complete all areas of this form. Please only answer the questions that are applicable to your evaluation)

Float Pool Member Information
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid date format of MM/DD/YYYY.
calendar
Job Knowledge and Practices
Space Cell Exceeds expectationsMeets expectationsNeeds improvement
Skillfully uses equipment, software, and tools required to do the job
Has good attendance; shows up on time and when scheduled
Planning, Organizing, and Problem Solving
Space Cell Exceeds expectationsMeets expectationsNeeds improvement
Handles multiple tasks smoothly and efficiently
Identifies and independently solves problems whenever possible
Responds professionally to problems or conflicts that arise in the work place
Knows when to ask for help from a supervisor or colleagues
Patient Focus
Space Cell Exceeds expectationsMeets expectationsNeeds improvement
Maintains a positive attitude with patients, even under pressure
Provides quality patient service to ALL patients
Teamwork
Space Cell Exceeds expectationsMeets expectationsNeeds improvement
Contributes to a positive, professional work environment
Works cooperatively and collaboratively with others
Adaptability
Space Cell Exceeds expectationsMeets expectationsNeeds improvement
Is open to suggestions for improvement in personal work practices
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