Clinical Evaluation Form

ACTIVITIES                                                         

3

2

1

Comments

I

Work Performance

1.

Applies theoretical knowledge to practice

2

Identify patient/ nursing care needs

3

Carries out/ follows instructions

4

Completes assigned work/tasks

5

Participates in unit activities

II

Leadership/management skills

1

Plans and organizes work of self and others

2

Locates and identifies policies and procedure

3

Reads relevant document (allocation, rota)

4

Communicates effectively with HN/ChN/ TL

5

Cooperates with nursing staff and colleague

III

Attitude & Professional behavior

1

Attendance (punctuality, breaks, post conf)

2

Maintains professional appearance

3

Shows sense of responsibility/accountability

4

Accepts constructive criticism

5

Seeks learning experience/ utilize time

IV

Reporting and charting

1

Records/ reports significant information

2

Submits reports on time and complete in numbers

3

Includes complete data (date,

4

Uses correct terms & appropriate forms

5

Presents in organized and neat manner