Staff Evaluation

Staff 001
Staff Relations

Strongl
y
Agree

1. He/She is easy to communicate with the

other office staff in the practice.
2. Have opportunities to interact with the
doctor(s).

3. It is important to hold regular staff meetings.

Agree

5. Duties are clearly defined.

6. Have opportunities to get training to do my

work.

7. Enjoyed the work He/She is doing.

9. Fells he/she is well paid for his/her work.

10. Feels that the benefits and pay the nurse

receives are adequate.

Patient Relations

Always

Usually

1. He/She greet patients by name as soon as

they enter the station.

Not Often

3. He/She answers the patients questions

thoroughly and courteously.

5. He/She with the doctors have a friendly

and caring attitude toward patients.
6. Patients generally are satisfied with his/her
practice.
7. The staff is liked by the patients.

Someti
mes

2. He/She send practice information to new

patients when they arrived at the station.

4. He/She treat each patient as if he/she were

a guest in our station.

Strongly
Disagree

4. The doctor(s) is/are appreciative of the

nurses work.

8. Participates to fellow staff members work as

a team to foster a good work environment.

Disagr
ee

Remarks:
Staff had demonstrated sense of responsibility to his patients.
Stayed calm even though

he needs to handle multiple patients at a time in his station.

Staff Evaluation
Staff 002
Staff Relations

Strongl
y
Agree

1. He/She is easy to communicate with the

other office staff in the practice.
2. Have opportunities to interact with the
doctor(s).

Agree

3. It is important to hold regular staff meetings.

4. The doctor(s) is/are appreciative of the

nurses work.

5. Duties are clearly defined.

6. Have opportunities to get training to do my

work.

7. Enjoyed the work He/She is doing.

8. Participates to fellow staff members work as

a team to foster a good work environment.
9. Fells he/she is well paid for his/her work.

10. Feels that the benefits and pay the nurse

receives are adequate.

Patient Relations
1. He/She greet patients by name as soon as
they enter the station.

Always

Usually

4. He/She treat each patient as if he/she were

a guest in our station.
5. He/She with the doctors have a friendly
and caring attitude toward patients.
6. Patients generally are satisfied with his/her
practice.
7. The staff is liked by the patients.

Someti
mes

2. He/She send practice information to new

patients when they arrived at the station.
3. He/She answers the patients questions
thoroughly and courteously.

Disagr
ee

Strongly
Disagree

Not Often

Remarks:
Stayed focus on her work. Able to address most of the patients
needs.

Staff Evaluation
Staff 003
Staff Relations

Strongl
y
Agree

1. He/She is easy to communicate with the

other office staff in the practice.
2. Have opportunities to interact with the
doctor(s).

Agree

4. The doctor(s) is/are appreciative of the

nurses work.

5. Duties are clearly defined.

6. Have opportunities to get training to do my

work.

8. Participates to fellow staff members work as

a team to foster a good work environment.

9. Fells he/she is well paid for his/her work.

10. Feels that the benefits and pay the nurse

receives are adequate.

Patient Relations

Always

1. He/She greet patients by name as soon as

they enter the station.

Usually

4. He/She treat each patient as if he/she were

a guest in our station.
5. He/She with the doctors have a friendly
and caring attitude toward patients.
6. Patients generally are satisfied with his/her
practice.

Someti
mes

2. He/She send practice information to new

patients when they arrived at the station.
3. He/She answers the patients questions
thoroughly and courteously.

Strongly
Disagree

3. It is important to hold regular staff meetings.

7. Enjoyed the work He/She is doing.

Disagr
ee

Not Often

7. The staff is liked by the patients.

Remarks:
Work harmoniously together with her co-staff in the station. Has a
good sense of humor.
Approachable per patients s/o remarks.

Staff Evaluation
Staff 004
Staff Relations
1. He/She is easy to communicate with the
other office staff in the practice.
2. Have opportunities to interact with the
doctor(s).

Strongl
y
Agree

Agree

4. The doctor(s) is/are appreciative of the

nurses work.

5. Duties are clearly defined.

6. Have opportunities to get training to do my

work.

7. Enjoyed the work He/She is doing.

9. Fells he/she is well paid for his/her work.

10. Feels that the benefits and pay the nurse

receives are adequate.

Patient Relations
1. He/She greet patients by name as soon as
they enter the station.
2. He/She send practice information to new
patients when they arrived at the station.
3. He/She answers the patients questions
thoroughly and courteously.
4. He/She treat each patient as if he/she were
a guest in our station.
5. He/She with the doctors have a friendly
and caring attitude toward patients.

Strongly
Disagree

3. It is important to hold regular staff meetings.

8. Participates to fellow staff members work as

a team to foster a good work environment.

Disagr
ee

Always

Usually

Someti
mes

Not Often

6. Patients generally are satisfied with his/her

practice.
7. The staff is liked by the patients.

Remarks:
Demonstrated and successfully fulfill her duties to the patients at
the end of the shift.
Able to provide helpful advices to the patients s/o prior discharge.
Have a good
communication skills not only to her colleagues but also to the
patient and their s/o .

Patient Satisfaction Survey

Dear Patient:
I am interested in finding out how your feel about various aspects in this Hospital. Please take a
minute to complete this questionnaire about your visit/confinement to this hospital. Your
responses are confidential and are greatly appreciated. Thank you.
Please rate each of the following:

Excellen
t

1. The convenience of the office location. (Consider

travel time, access by public transportation, and
parking.)
2. The accessibility of the office. (Is the office easy to
find, are stairs or elevators readily available, is
handicapped entrance adequate, etc.)

Good

3. The comfort of the reception area.

4. The attractiveness of the reception area.

5. The comfort of the examining room(s).

6. The cleanliness of the office, including the reception

area and examination room.
7. The courtesy of the staff.

Fair

8. The amount of time spent with your physician.

9. The communication with your physician.

10. The quality of the care you received.

11. The privacy of the physicians consultation room

and the examination room.

Poor

12. Overall, how would you rate your experience?

13. Do you have any additional comments?

NONE

Patient Satisfaction Survey

Dear Patient:
I am interested in finding out how your feel about various aspects in this Hospital. Please take a
minute to complete this questionnaire about your visit/confinement to this hospital. Your
responses are confidential and are greatly appreciated. Thank you.
Please rate each of the following:

Excellen
t

1. The convenience of the office location. (Consider

travel time, access by public transportation, and
parking.)
2. The accessibility of the office. (Is the office easy to
find, are stairs or elevators readily available, is
handicapped entrance adequate, etc.)

Good

3. The comfort of the reception area.

4. The attractiveness of the reception area.

5. The comfort of the examining room(s).

6. The cleanliness of the office, including the reception

area and examination room.
7. The courtesy of the staff.

8. The amount of time spent with your physician.

9. The communication with your physician.

10. The quality of the care you received.

Fair

Poor

11. The privacy of the physicians consultation room

and the examination room.

12. Overall, how would you rate your experience?

13. Do you have any additional comments?

The service is good. The staff was able to provide what the patient needs.

Patient Satisfaction Survey

Dear Patient:
I am interested in finding out how your feel about various aspects in this Hospital. Please take a
minute to complete this questionnaire about your visit/confinement to this hospital. Your
responses are confidential and are greatly appreciated. Thank you.
Please rate each of the following:
1. The convenience of the office location. (Consider
travel time, access by public transportation, and
parking.)
2. The accessibility of the office. (Is the office easy to
find, are stairs or elevators readily available, is
handicapped entrance adequate, etc.)
3. The comfort of the reception area.
4. The attractiveness of the reception area.

Excellen
t

Good

5. The comfort of the examining room(s).

6. The cleanliness of the office, including the reception
area and examination room.

7. The courtesy of the staff.

8. The amount of time spent with your physician.

9. The communication with your physician.

Fair

Poor

10. The quality of the care you received.

11. The privacy of the physicians consultation room

and the examination room.

12. Overall, how would you rate your experience?

13. Do you have any additional comments?

NONE

Patient Satisfaction Survey

Dear Patient:
I am interested in finding out how your feel about various aspects in this Hospital. Please take a
minute to complete this questionnaire about your visit/confinement to this hospital. Your
responses are confidential and are greatly appreciated. Thank you.
Please rate each of the following:
1. The convenience of the office location. (Consider
travel time, access by public transportation, and
parking.)
2. The accessibility of the office. (Is the office easy to
find, are stairs or elevators readily available, is
handicapped entrance adequate, etc.)
3. The comfort of the reception area.

Excellen
t

Good

Fair

4. The attractiveness of the reception area.

5. The comfort of the examining room(s).

6. The cleanliness of the office, including the reception

area and examination room.
7. The courtesy of the staff.

8. The amount of time spent with your physician.

Poor

9. The communication with your physician.

10. The quality of the care you received.

11. The privacy of the physicians consultation room

and the examination room.

12. Overall, how would you rate your experience?

13. Do you have any additional comments?

NONE