Quarterly Staff Self-Evaluation Form
Complete this form prior to your performance review to help guide the discussion. Be specific and thorough in your responses. If you have any questions or experience technical issues, please contact ops@infinitydiagnosticscenter.com.
Today's Date
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Month
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Day
Year
Current Date
Start Date with Company
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Month
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Day
Year
Select Date of Hire
What is the best day to schedule your evaluation? (Select all that apply)
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Other
What is the best time to schedule your evaluation? (Select all that apply)
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Morning
Afternoon
Other
Full Name
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Personal Email Address
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example@example.com | Please note, this will be used to send a copy of your responses to you for personal record keeping purposes.
Select Department(s)
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Arabella Chiropractic - Houston
Arabella Chiropractic - Willowbrook
Head to Toe Chiropractic
Imaging - Beaumont
Imaging - El Paso
Imaging - Houston
Imaging - Pasadena
Prestige Medical Clinic - Houston
Prestige Medical Clinic - Pasadena
Prestige Medical Clinic - Willowbrook
Streamline Medical Injury Solutions - Chiro
Streamline Medical Injury Solutions - Physical Therapy
Streamline Medical Injury Solutions - MD
Streamline Medical Injury Solutions - Pain Management
Streamline Medical Injury Solutions - Imaging
Streamline Medical Injury Solutions - Specialty
Vital Surgical Solutions
Other
Job Title
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Key Accomplishments
1. What were your most significant achievements during this period?
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Challenges
2. What challenges did you face and how did you handle them?
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Growth Opportunities
3. What skills or areas would you like to improve in?
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Future Goals
4. What are two goals you aim to achieve by the next evaluation?
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Feedback
5. Do you have any suggestions or feedback for improving the workplace or your role?
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If not applicable, type "N/A"
OPTIONAL SECTION
Upload any relevant awards, certifications, community engagement photos, reviews, work samples, or other documents you believe are important to be considered for the upcoming quarterly evaluation. This is optional and is not required.
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