CNA PERFORMANCE EVALUATION

Name:

THIS FORM IS ONLY FOR YOUR SUPERVISOR AT YOUR FACILITY TO FILL OUT!

545 Broadway 3rd Floor Brooklyn, NY 11206 (T) 718 305 6700 (F) 718 305 6824



Facility:

We take staffing close to our heart.

CNA PERFORMANCE EVALUATION

Responsibilities

Outstanding

I. Clinical Process

Performs direct care services in accordance with Resident's Care Plan.

Performs tasks necessary to help resident in personal hygiene.

Very Good

Good

Marginal

Poor

Areas for Improvement

Assists patients in and out of their beds, baths or showers, eat or drink, and keeps the resident's room clean at all time.

II. Communication/Interpersonal Relations

Communicates well with the doctors and nurses regarding pa- tient's needs.

Contributes to meeting the emotional, spiritual, and recreational needs of patients by being aware and understanding of their needs.

Demonstrates the ability to cooperate, work and communicate with coworkers, supervisors, sub- ordinates and/or outside contacts.

III. Safety Awareness

Follows safety and conduct rules. Adherence to company policies and regulations.

Assumes responsibility for safe work habits and supports/ reinforces policies regarding pa- tient care and infection control.

Rated By:

I certify that this performance assessment has been discussed and explained to me fully by the rater.

Signature: Name: Position: Date:

Employee's Signature:

Date:

I certify that this performance assessment was discussed and explained fully to the employee over the phone:

Discussed by:

Date:

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download