Sample Employee Of The Month Peer Nomination Form (Page 3 of 4) in pdf

Sample Employee Of The Month Peer Nomination Form Page 3

MANAGER SCREENING TOOL

Nominee:____________________________________ Dept/Area:______________________Date:_______________

Nominated by:_________________________________________Number of Nominations to date:_______________

DESCRIPTOR

ALWAYS

OFTEN

NEVER

COMMENTS

Adheres to department dress code and maintains a neat appearance

Demonstrates reliability and dependability

Demonstrates good ambassadorship for UAMS

Exhibits the 3 C’s: Care, Commitment, and Contribution

Exceeds expectations and is willing to go the extra mile

Accepts change

Identifies problems and quality issues

Communicates constructively and informatively

Uses constructive feedback to improve performance

Applies effective communication skills (verbal and nonverbal) in all interactions with

patients, peers, other departments and the public

Demonstrates willingness to share knowledge with coworkers

Supports others in the performance of duties

Demonstrates ability to assist with orienting new personnel

Displays qualities of a team player

Has nominee been placed on verbal or written warning within the past year?

Yes_______ No _______

Is yes, please explain:

_________________________________________________________________

Name of Manager/Supervisor:__________________ Phone:_________________________

Sample Employee Of The Month Peer Nomination Form Page 3