CareStat, LLC



CareStat, LLC

Home Health Services

90 Day Performance Review

___________________________ was hired on ________________ in the current position of _______________________.

As you know, we follow a policy that specifically states that all employees will have a performance evaluation after 90 days of employment. Please complete this form indicating your opinions based on performance during this period. If you have any question, please contact HR.

Outstanding Above Average Below Totally

Average Average Unsatisfactory

Job knowledge_________________________________________________________________

Effectiveness___________________________________________________________________

Quality of Work________________________________________________________________

Dependability__________________________________________________________________

Initiative______________________________________________________________________

Judgement_____________________________________________________________________

Cooperation____________________________________________________________________

Potential______________________________________________________________________

Additional Comments:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Has this employee been promoted? Yes or No? If the answer to this question is yes, please list the former position and the new position.

__________________________________promoted to ______________________________this promotion began or will begin on _________________________________.

_____________________________________ _____________________

Employee Signature Date

_____________________________________ _____________________

Supervisors Signature Date

Revised 8-9-08

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