Appraisee Name - GP SURGERY MANAGER



Appraisee Name: Department:

Job Title: Appraiser Name:

Your Name I wish to remain anonymous [YES] [NO]

What is your work relationship with the Appraisee?

[I am his/her manager] [I am his/her peer] [I report to him/her]

How to complete this questionnaire:

Your responses to this questionnaire, in conjunction with responses from other people, are intended to provide your colleague with feedback on some aspects of his/her performance and management style.

To the right of each item is a 5 point scale. From the options listed below, please select and mark with a tick the one that represents your view of your colleague’s performance in his/her current job.

1 = strongly agree, 2 = somewhat agree, 3 = neither agree or disagree, 4 = somewhat disagree, 5 = strongly disagree

To the left of each item is a tick box ‘No evidence/not relevant’ – only tick this box when you feel you have insufficient experience of the individual to make a valid judgement.

Avoid if you can repeatedly selecting the middle of the scale. Try to make full use of the rating scale. Be honest; remember you are helping your colleagues with his/her personal development. Make your colleague’s strengths and weaknesses really stand out.

Be as fair and objective as possible. Base your judgements on your own direct experience of the individual and not on hearsay or any perceived general view. You should be able to base your judgements on some evidence you have actually observed. Avoid allowing a particularly prominent characteristic of your colleague – whether favourable or unfavourable – to colour your judgement in other areas.

ALL in ALL be FAIR, be CONSISTENT, and be POSITIVE. Your colleague may ben asked to complete one of these questionnaires in respect of you.

CONFIDENTIALITY

Return this questionnaire to your colleague’s appraiser. Under normal circumstances, the Appraisee will not be able to identify which colleague provided each rating against a particular item. The appraiser will collate all the responses from all the colleagues and provide feedback. However, you should be aware that the colleague may request to see individual responses, and will be entitled to access them. Please do not share your responses with anyone else.

QUESTIONNAIRE

Please return this questionnaire to your colleague’s appraiser in a confidential envelope by (insert date)

________________________________________________________________________________

No evidence/ Please circle the one number

Not relevant which best fits your view.

[please tick] Strongly Strongly

agree disagree

________________________________________________________________________________________________

□ Emphasises the need for quality in everything he/she does 1 2 3 4 5

□ Focuses his/her efforts on the client/patient 1 2 3 4 5

□ Delegates effectively 1 2 3 4 5

□ Provides constructive feedback to help me with my job 1 2 3 4 5

□ Always recognises my achievement with praise 1 2 3 4 5

□ Is self motivated 1 2 3 4 5

□ Encourages me to achieve my full potential 1 2 3 4 5

□ Acts like a coach/mentor 1 2 3 4 5

□ Is more encouraging than critical 1 2 3 4 5

□ Seeks to create ‘team’ working 1 2 3 4 5

□ Encourages cooperation as opposed to competition

between individuals 1 2 3 4 5

□ Encourages cooperation as opposed to competition

between ‘teams’/departments/sections 1 2 3 4 5

□ Supports the practice team 1 2 3 4 5

□ Is actively involved in practice team meetings 1 2 3 4 5

□ Listens to me attentively 1 2 3 4 5

□ Keeps me informed of practice developments

that affect me 1 2 3 4 5

□ Is an effective oral communicator 1 2 3 4 5

□ Is an effective written communicator 1 2 3 4 5

□ Is accessible when I need to discuss something 1 2 3 4 5

□ Handles differences of opinion sensitively 1 2 3 4 5

□ Negotiates effectively 1 2 3 4 5

□ Is objective when dealing with problems 1 2 3 4 5

□ Is pro-active in developing solutions to problems 1 2 3 4 5

□ Actively seeks to influence events to achieve goals 1 2 3 4 5

□ Is concerned with long term issues not only short term issues 1 2 3 4 5

□ Manages change effectively 1 2 3 4 5

□ Understands the impact and implications of his/her

Decisions/ actions on other areas of the practice 1 2 3 4 5

□ Is committed to the success of the practice 1 2 3 4 5

□ Is flexible 1 2 3 4 5

□ Is well organised 1 2 3 4 5

□ Displays energy and enthusiasm 1 2 3 4 5

□ Treats me with respect 1 2 3 4 5

□ Is approachable 1 2 3 4 5

□ Is a consistent performer under pressure 1 2 3 4 5

□ Is honest and open with me 1 2 3 4 5

□ Can be trusted with confidential and sensitive matters 1 2 3 4 5

□ Manages his/her time effectively 1 2 3 4 5

□ Prioritises well 1 2 3 4 5

□ Is prepared to ask for help when required 1 2 3 4 5

□ Is up to date in his/her field of expertise 1 2 3 4 5

□ Shares his/her knowledge and skills 1 2 3 4 5

What did you particularly like about what the Appraisee did last year?

What could the Appraisee do differently to improve their performance?

Do you have any other comments? (Write overleaf)

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