SUPERVISOR PERFORMANCE REVIEW/EVALUATION RATING:

Employees Name: EMILY VASQUEZ Review Period: February 01 April 30, 2017
Position Title: Officer-in-Charge (OIC) - Pharmacy Unit Date:____________________________
Department: Pharmacy
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You are asked to complete this form for the above-named supervisor or colleague. Please use your knowledge of this persons
work, decision-making, attitude, capabilities and commitment by putting a check mark corresponding to your rating on the space
provided for each of the following:
1. Shows Respect for Colleagues and Customers 3 Neutral
5 Strongly Agree 2 Disagree
4 Agree 1 Strongly Disagree
3 Neutral 8. Creates a Healthy & Positive Work Environment
2 Disagree 5 Strongly Agree
1 Strongly Disagree 4 Agree
2. Communicates/Collaborates Well in a Team 3 Neutral
5 Strongly Agree 2 Disagree
4 Agree 1 Strongly Disagree
3 Neutral 9. Treats Everyone with Fairness and Professionalism
2 Disagree 5 Strongly Agree
1 Strongly Disagree 4 Agree
3. Possesses Leadership Skills and Managerial Ability 3 Neutral
5 Strongly Agree 2 Disagree
4 Agree 1 Strongly Disagree
3 Neutral 10. Honest, Competent, Hardworking, Dependable
2 Disagree 5 Strongly Agree
1 Strongly Disagree 4 Agree
4. Helpful, Approachable, Supportive, Encouraging 3 Neutral
5 Strongly Agree 2 Disagree
4 Agree 1 Strongly Disagree
3 Neutral
2 Disagree What is your overall assessment? Recommendations?
1 Strongly Disagree ________________________________________________
5. Makes Sound/Logical Job-related Decision/Judgment ________________________________________________
5 Strongly Agree ________________________________________________
4 Agree ________________________________________________
3 Neutral ________________________________________________
2 Disagree ________________________________________________
1 Strongly Disagree ________________________________________________
6. Open-minded, Listens to Constructive Comments ________________________________________________
5 Strongly Agree ________________________________________________
4 Agree ________________________________________________
3 Neutral
2 Disagree
1 Strongly Disagree ____________________________
Evaluators Name and Signature

7. Serves as a Good Example/Role Model for Others

5 Strongly Agree
4 Agree