3-Months Caregiver Evaluation Review

	Criteria Score (1-5)
Demonstrates empathy and compassion
Responsiveness to client needs
Maintains client dignity and respect
Provides care and visit notes according to client’s care plan
Exhibits patience and attentiveness

	Criteria Score (1-5)
Maintains punctuality and regular attendance
Follows policies and procedures
Communicates effectively with clients and families
Demonstrates reliability and dependability
Consistently wears the company’s uniform or clean scrubs, upholding professional standards.

	Criteria Score (1-5)
Communicates clearly and effectively with team
Accepts and applies feedback from supervisors
Supports coworkers and promotes team collaboration
Maintains a positive attitude and professionalism

	Criteria Score (1-5)
Consistently follows health and safety protocols
Demonstrates safe handling and mobility skills
Ensures cleanliness and hygiene standards

	Criteria Score (1-5)
Shows initiative in providing quality care
Pursues ongoing training or skill improvement

Section 5 Total Score:
Overall Rating
Score Range Performance Rating
81 - 90: Excellent
71 - 80: Good
61 - 70: Satisfactory
51 - 60: Needs Improvement
Below 50: Unsatisfactory
Final Rating:
Comments and Recommendations
Strengths:
Areas for Improvement:
Goals for Next Review Period:
Supervisor Comments:
Employee's Acknowledgment

I have reviewed and discussed this evaluation with my supervisor.
Employee Signature:

Clear
Date:

MonthDayYear
Date
Supervisor Signature:

Clear
Date:

MonthDayYear
Date
Should be Empty:

Section 1: Quality of Client Care (Total Possible Points: 25)