Duluth Care

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    STAFF YEARLY EVALUTATION AND REVIEW FORM

    Agency Evaluation will be done every year from date of employment for each staff person.

    Staff name:

    Agency Supervisor:

    Staff date of hire:

    Date of evaluation:

    Staff address:

    Staff email:

    We welcome your comments about the services that have been offered to you. Please complete the following details so that we can continue to offer the best service possible. Pass them to your instructor at the end of the course. Please place a check mark in the appropriate box for your answer. When you are finished with this side please complete the sections located on the back of this form.

    Overall Service Satisfaction

    Poor

    Average

    Good

    Excellent

    Does the staff know the emergency contact number for the client complaint line and the agency after hours contact?

    Is the position suited for the staff based on their own qualifications?

    Was the staff's appearance professional?

    Is the staff on the time to each shift?

    How well did the staff follow the plan of care?

    Overall satisfaction with staff communication and feedback

    Overall rating of your staff's competence in providing the care to you

    Staff's ability to provide accurate instructions to the client when applicable

    Is the staff educated on how to complete a weekly task sheet according to the client plan care?