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EMPLOYEE:
DATE OF EVAL:
REPORTS TO:
DATE OF HIRE:
OFFICE: CALHOUN
CARTERSVILLE
ANNUAL EVALUATION
90 DAY EVALUATION
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Employees Signature
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Date
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Evaluators Signature
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Date
Evaluator
Rating Score
AREAS OF
PERFORMANCE
EVIDENCE/RESPONSIBILITIES OF
STANDARD COMPLIANCE
EVALUATION
TOOLS USED
ASSESSMENT
Observation
Record Review
ADDRESSING
PATIENT NEEDS
Observation
Record Review
PERSONNEL
MANAGEMENT
CREATING AND
CONFIRMING
APPOINTMENTS
Observation
Record Review
Observation
Record Review
Employee
Evaluation
Self
Evaluation
Rating
Evaluator
Rating Score
AREAS OF
PERFORMANCE
EVIDENCE/RESPONSIBILITIES OF
STANDARD COMPLIANCE
EVALUATION
TOOLS USED
TECHNICAL
KNOWLEDGE IN
ECLINICALS
Observation
Record Review
EDUCATION
Education Review
PROFESSIONALISM
INVENTORY
MANAGEMENT
COMMUNICATION
AND
DOCUMENTATION
Ensures all shots, products, and supplies are in stock and stored
safely
Reviews and approves all supply requisitions in a timely manner
Maintains safety and cleanliness of all equipment and inventory
Documents all vaccines administered for state and private insurance
Monitors all lab results accurately
Promptly and efficiently handles all insurance chart reviews
Responds to voicemails promptly and effectively
Communicates the minimum required patient information in all
interactions with outside facilities
Communicates effectively with providers regarding scheduling
needs
Addresses all calls within expertise
Understands issues that must be brought before a provider
Self
Evaluation
Rating
Observation
Record Review
Observation
Record Review
Observation
Record Review
1. ASSESSMENT: Include areas identified as needing improvement as well as areas that exceed expectations
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3. ADDRESSING PATIENT NEEDS: Include areas identified as needing improvement as well as areas that
exceed expectations
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4. PERSONNEL MANAGEMENT: Include areas identified as needing improvement as well as areas that
exceed expectations
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6. EDUCATION: Include areas identified as needing improvement as well as areas that exceed expectations
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7. PROFESSIONALISM: Include areas identified as needing improvement as well as areas that exceed
expectations
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8. INVENTORY MANAGEMENT: Include areas identified as needing improvement as well as areas that
exceed expectations
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