Employee Evaluation Form printable pdf download

EMPLOYEE EVALUATION FORM

(S.A.R.P.H. EEF)

(To be completed by pharmacist’s direct supervisor)

Name of Employee: __________________________

Quarter of _______

(year)

Please indicate after the following questions your evaluation of the professional performance of the above named pharmacist. The

purpose of this evaluation is to provide monitoring information to the individual’s S.A.R.P.H. monitor, S.A.R.P.H. officers, PHMP

casemanager and/or to the Board of Pharmacy. It is understood by all parties that this information is confidential and will only be

divulged to those persons named in the participant’s S.A.R.P.H. contract and/or, if applicable, pursuant to a Board Order.

The above named pharmacist: (Rank: 1- Strongly Agree; 5 – Strongly Disagree)

Has been punctual and regular in attendance to work.

Agree 1

Disagree

Has a good attitude about their employment.

Agree 1

Disagree

Relates well to other health care professionals.

Agree 1

Disagree

Works well with other employees.

Agree 1

Disagree

Handles customers/patients and their questions well.

Agree 1

Disagree

Overall quality of work performance

_____ Excellent

_____ Good

_____ Fair

_____ Poor

Rate the pharmacist’s over all appearance and general health.

_____ Good _____ Fair

_____ Poor

_____ Deteriorating

Comments (favorable or unfavorable): __________________________________

_________________________________________________________________

Employer, Supervisor name and signature: _____________________________

Pharmacy: ______________________________________ Phone: _________________

Address: ________________________________________________________________

Questions or Information regarding this form? Call, Fax or Write to:

S.A.R.P.H. 258 Wolfe Lane, Irwin, PA 15642 Due: March, June, September, December

Phone : (800) 892-4484

Fax: (724) 446-7399

Employee Evaluation Form