‘As an on-going commitment to ensure our service delivery is kept at an optimal standard it would be appreciated if you can complete the following post-placement assessment form. Agency Worker — End of Placement Assessment Form AG) group MEDICAL STAFFING Teeny Worker Name! very Maen pets fx Professional Reg. number Postion/Miain Duty: | £7 Ward or Unit placed: Herihown cve, Length of agency assignment: | 9 -/S ——p Q[- =D Please state the duties the Agency Worker performed: ASSESSMENT POINTS: _O~Didnotobserve _1-Needs improvement __2~Mests expectations __3strengthin thsarea Please was Assessment Criteria appropriate COMMENTS o[s[2[s ‘ASSESSMENT AND DOCUMENTATION Skis demonetrated in line with 9 the requirements ofthe position & orks to the required standards Patient records & other records ‘management “Manages patient oad effectively to eve ‘optimal care in 2 timely manner al COMMUNICATION ales with shit leader regarding Consruniates Gevay wt ot colleagues & public ie PROFESSIONALISM Poo Pmeteesing— on tine & prepared Uniform & ID badge policy adhered to Have you had any reason to be dissatisfied with the Agency Worker's services? ifyes, please provide details: | A Please provide any further information which is relevant to the Agency Worker's performance Yes COMPLETED BY: eres @isumama ‘weealpean Jam _|rosiion [Aone iA Cha Senetire oh vate | fae Teno CTF 22. 2d, Email - Seen aes HL. preg ~ NiCTe s CoMMUNUTY Hospi Only Official Verifiable Confirmation Accepte + Organisation Stamp + Signed Complimentary Slip + Returned from official work email address Oras Cee ee od 3