Member Feedback

In order to maintain our high standards of service, we offer Clients the opportunity to evaluate the performance of our Agency Staff at the end of an assignment. This feedback is crucial to ensure we continue to provide quality staff and constructive feedback to our Nurses/Healthcare Assistants. We would be extremely grateful if a senior member of staff who supervised the individual named below could complete the form below;

Members Name (required)

Position(required)

Clients name(required)

Assignment details

Staff Rating and skills assessment (1 = very poor / 5 = outstanding)

1. The standard of skills and professionalism shown? 12345

2. Their level of motivation and initiative? 12345

3. Ability to integrate with the rest of the team? 12345

4. Relationship with Line Managers? 12345

5. Compliance with all local policies and procedures? 12345

6. The standard of reports and records maintained? 12345

7. The quality of the care provided to patients and their families? 12345

8. Their overall appearance? 12345

9. Overall competence rating? 12345

10. Would you use this agency worker again? YesNo

Your name (required)

Position(required)

Date(required)

Please initial as a signature?

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