Team Member Evaluation Form

Team Member Evaluation Form

Provider Feedback
Provider Name
Date

MonthDayYear

Evaluate the team members

	Job Knowledge & Skills	Work Quality & Productivity	Attitude & Teamwork	Communication	Attendance & Dependability	Patient Interaction/Continuity of Care
Jessica Brazell
Kaitlyn Cormier
Sheila Lemaire
Emily Shamsie
Amanda Simon
Mckayla Taylor
Kathy Trosclair

Evaluate the team members

	Overall Job Performance	Comments
Jessica Brazell
Kaitlyn Cormier
Sheila Lemaire
Emily Shamsie
Amanda Simon
Mckayla Taylor
Kathy Trosclair

Rate the Team Overall
Providing Weekly Report Updates
Fair Work Distribution
Respect Each Other
Help Each Other
Completion of Individual Tasks
Committed To Team Goals
On a scale of 1-10, how happy are you with your team?

1

2

3

4

5

6

7

8

9

10

1 is Very Low, 10 is Very High
Do you have any general observations on the dynamics of your team? Is there anything you could recommend to make it better?
Should be Empty: