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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.
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This question requires a valid date format of MM/DD/YYYY.
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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

Personal and Team Relationships *This question is required.
Space Cell Exceeds expectationsMeets expectationsNeeds improvement
Speaks and acts in a way that make others comfortable
Acts in ways that earns respect and trust from others in the workplace
Behaves in a consistent and dependable manner
Treats co-workers with respect and courtesy
Receives feedback in an open-minded way
Receives feedback in an open-minded way
Is open and approachable to others

Adaptability
Space Cell Exceeds expectationsMeets expectationsNeeds improvement
Is open to suggestions for improvement in personal work practices

Basic Skills *This question is required.
Space Cell Exceeds expectationsMeets expectationsNeeds improvement
Speaks in a clear and understandable voice
Uses vocabulary and tone of voice to communicate information effectively
Demonstrates patience and concentration with listening to others
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