Employee
Please fill out top three lines and give form to the health care professional you are assigned to at the Hospital. Have them complete this form and return it to the Internal Health Careers Specialist through interoffice mail.
Employee Name:__________________________________________________________________________
Current Job Title and Department:_____________________________________________________________
Department and Career of Interest:____________________________________________________________
Date and Time of Experience:________________________________________________________________
Health Care Professional
Please complete this evaluation of the Employee named above based on the criteria below and send it through interoffice mail to the Internal Health Careers Specialist (Brittni Beers) located on the 5th floor in office number 5316 or Salem Hospital HR. Thank you for your time and assistance with the Career Exploration Program!
Health Care Professional Name:______________________________________________________________
Job Title and Department:____________________________
Criteria: 1 = Needs Improvement, 2 = Acceptable, 3 = Good, 4 = Excellent |
Preparation |
Employee came prepared with questions |
1 2 3 4 N/A |
Employee made good use of time |
1 2 3 4 N/A |
Employee took notes |
1 2 3 4 N/A |
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Patient Interaction |
Employee is respectful of all patient rights |
1 2 3 4 N/A |
Employee interacts appropriately with patients |
1 2 3 4 N/A |
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Focus |
Employee demonstrates compassion in all interactions |
1 2 3 4 N/A |
Employee was cooperative and courteous in all interactions with staff |
1 2 3 4 N/A |
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Integrity |
Employee arrives on time |
1 2 3 4 N/A |
Employee is appropriately dressed |
1 2 3 4 N/A |
Employee behaves professionally at all times |
1 2 3 4 N/A |
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Resourcefulness |
Employee remains attentive during experience. |
1 2 3 4 N/A |
Employee provides own journal materials and evaluation form |
1 2 3 4 N/A |
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Stewardship |
Employee asks appropriate questions at appropriate times and places |
1 2 3 4 N/A |
Employee uses available time to complete paperwork or ask question |
1 2 3 4 N/A |
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Teamwork |
Employee demonstrates flexibility in response to ongoing activity |
1 2 3 4 N/A |
Employee reflects appropriate atmosphere and attitude in all encounters |
1 2 3 4 N/A |
Employee readily accepts direction and guidance |
1 2 3 4 N/A |
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