Home Health Aide Performance Evaluation

Employee Location *

Employee First Name *

Employee Last Name *

Employee Email *

Evaluation Period Start *

Evaluation Period End *

Evaluator First Name *

Evaluator Last Name *

Evaluator Title *

Demonstrates compassion and patience with clients (1-7, 1=lowest, 7=highest) *

Provides personal care services according to the care plan (1-7, 1=lowest, 7=highest) *

Maintains client's environment in a clean and safe manner (1-7, 1=lowest, 7=highest) *

Communicates effectively with clients, families, and team members (1-7, 1=lowest, 7=highest) *

Reports changes in client's condition promptly (1-7, 1=lowest, 7=highest) *

Documents are provided accurately and comprehensively (1-7, 1=lowest, 7=highest) *

Arrives on time for scheduled shifts (1-7, 1=lowest, 7=highest) *

Shows reliability in completing assigned tasks (1-7, 1=lowest, 7=highest) *

Follows agency policies and procedures (1-7, 1=lowest, 7=highest) *

Maintains client confidentiality (1-7, 1=lowest, 7=highest) *

Demonstrates respect for clients and their property (1-7, 1=lowest, 7=highest) *

Adheres to dress code and presents a professional image (1-7, 1=lowest, 7=highest) *

Works cooperatively with other team members (1-7, 1=lowest, 7=highest) *

Offers help to peers when needed (1-7, 1=lowest, 7=highest) *

Participates in staff meetings and training sessions (1-7, 1=lowest, 7=highest) *

Evaluator Comments (opportunity for growth and professional development) *

Overall Performance Rating (total possible score = 105) *

Evaluator Email *

Date-Time *

Evaluator Signature — type your full legal name to sign *