Supervisory Performance Evaluation
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1. Introduction

This form is to be used to evaluate your supervisor and to gain information about them. The results of these evaluations will not be shared with management and will remain confidential. We will use the information provided to identify supervisors who consistently rate/score low. However, it is important to provide us with your demographic information as well as we may need to contact you to get additional details or clarification as we move to the next process.

Please make this as accurate and fair as possible--"this is not a Witch Hunt". We need a serious appraisal of your supervisor, as their score will determine who will be "called out".

SUPERVISOR DEMOGRAPHIC QUESTIONS:

Is your supervisor an RN?

Is your supervisor an RN? YES

If not, what classification are they?

How many employees does your supervisor supervise?

PLEASE SELECT THE NUMBER ON THE RATING SCALE (1-5) THAT BEST APPLIES AS FOLLOWS:
1=Never, 2=Rarely, 3=Sometimes, 4=Most of the time, 5=Always.

COMMUNICATION:
Easily understood by others...

	1-Never	2-Rarely	3-Sometimes	4-Most of the time	5-Always
in discussions;	*COMMUNICATION: Easily understood by others... in discussions; 1-Never	in discussions; 2-Rarely	in discussions; 3-Sometimes	in discussions; 4-Most of the time	in discussions; 5-Always
in answering questions;	in answering questions; 1-Never	in answering questions; 2-Rarely	in answering questions; 3-Sometimes	in answering questions; 4-Most of the time	in answering questions; 5-Always
and making assignments	and making assignments 1-Never	and making assignments 2-Rarely	and making assignments 3-Sometimes	and making assignments 4-Most of the time	and making assignments 5-Always
Able to communicate clearly in written form.	Able to communicate clearly in written form. 1-Never	Able to communicate clearly in written form. 2-Rarely	Able to communicate clearly in written form. 3-Sometimes	Able to communicate clearly in written form. 4-Most of the time	Able to communicate clearly in written form. 5-Always

DEMONSTRATES RESPECT FOR ALL PEOPLE:

	1-Never	2-Rarely	3-Sometimes	4-Most of the time	5-Always
Demonstrates respect for people from a variety of ethnic, social, and cultural backgrounds.	*DEMONSTRATES RESPECT FOR ALL PEOPLE: Demonstrates respect for people from a variety of ethnic, social, and cultural backgrounds. 1-Never	Demonstrates respect for people from a variety of ethnic, social, and cultural backgrounds. 2-Rarely	Demonstrates respect for people from a variety of ethnic, social, and cultural backgrounds. 3-Sometimes	Demonstrates respect for people from a variety of ethnic, social, and cultural backgrounds. 4-Most of the time	Demonstrates respect for people from a variety of ethnic, social, and cultural backgrounds. 5-Always
Treats all employees fair and equally.	Treats all employees fair and equally. 1-Never	Treats all employees fair and equally. 2-Rarely	Treats all employees fair and equally. 3-Sometimes	Treats all employees fair and equally. 4-Most of the time	Treats all employees fair and equally. 5-Always

LEADERSHIP:
Easily understood by others...

	1-Never	2-Rarely	3-Sometimes	4-Most of the time	5-Always
Is fair, open and consisten with others.	*LEADERSHIP: Easily understood by others... Is fair, open and consisten with others. 1-Never	Is fair, open and consisten with others. 2-Rarely	Is fair, open and consisten with others. 3-Sometimes	Is fair, open and consisten with others. 4-Most of the time	Is fair, open and consisten with others. 5-Always
Promotes an environment where others feel involved.	Promotes an environment where others feel involved. 1-Never	Promotes an environment where others feel involved. 2-Rarely	Promotes an environment where others feel involved. 3-Sometimes	Promotes an environment where others feel involved. 4-Most of the time	Promotes an environment where others feel involved. 5-Always
Promotes an environment where others are recognized for accomplishments of group and individual goals.	Promotes an environment where others are recognized for accomplishments of group and individual goals. 1-Never	Promotes an environment where others are recognized for accomplishments of group and individual goals. 2-Rarely	Promotes an environment where others are recognized for accomplishments of group and individual goals. 3-Sometimes	Promotes an environment where others are recognized for accomplishments of group and individual goals. 4-Most of the time	Promotes an environment where others are recognized for accomplishments of group and individual goals. 5-Always
Defines problems effectively; gets to the heart of the problem.	Defines problems effectively; gets to the heart of the problem. 1-Never	Defines problems effectively; gets to the heart of the problem. 2-Rarely	Defines problems effectively; gets to the heart of the problem. 3-Sometimes	Defines problems effectively; gets to the heart of the problem. 4-Most of the time	Defines problems effectively; gets to the heart of the problem. 5-Always
Makes timely decision based on appropriate information.	Makes timely decision based on appropriate information. 1-Never	Makes timely decision based on appropriate information. 2-Rarely	Makes timely decision based on appropriate information. 3-Sometimes	Makes timely decision based on appropriate information. 4-Most of the time	Makes timely decision based on appropriate information. 5-Always
Manages the process of decision making effectively.	Manages the process of decision making effectively. 1-Never	Manages the process of decision making effectively. 2-Rarely	Manages the process of decision making effectively. 3-Sometimes	Manages the process of decision making effectively. 4-Most of the time	Manages the process of decision making effectively. 5-Always

JOB KNOWLEDGE:

	1-Never	2-Rarely	3-Sometimes	4-Most of the time	5-Always
Demonstrates clinical/nursing knowledge and skills necessary to perform on the unit if necessary;	*JOB KNOWLEDGE: Demonstrates clinical/nursing knowledge and skills necessary to perform on the unit if necessary; 1-Never	Demonstrates clinical/nursing knowledge and skills necessary to perform on the unit if necessary; 2-Rarely	Demonstrates clinical/nursing knowledge and skills necessary to perform on the unit if necessary; 3-Sometimes	Demonstrates clinical/nursing knowledge and skills necessary to perform on the unit if necessary; 4-Most of the time	Demonstrates clinical/nursing knowledge and skills necessary to perform on the unit if necessary; 5-Always
and possesses the professional licensure to evaluate RN skills.	and possesses the professional licensure to evaluate RN skills. 1-Never	and possesses the professional licensure to evaluate RN skills. 2-Rarely	and possesses the professional licensure to evaluate RN skills. 3-Sometimes	and possesses the professional licensure to evaluate RN skills. 4-Most of the time	and possesses the professional licensure to evaluate RN skills. 5-Always
Stays current with new developments, technologies, methods, approaches and processes in areas of responsibilities.	Stays current with new developments, technologies, methods, approaches and processes in areas of responsibilities. 1-Never	Stays current with new developments, technologies, methods, approaches and processes in areas of responsibilities. 2-Rarely	Stays current with new developments, technologies, methods, approaches and processes in areas of responsibilities. 3-Sometimes	Stays current with new developments, technologies, methods, approaches and processes in areas of responsibilities. 4-Most of the time	Stays current with new developments, technologies, methods, approaches and processes in areas of responsibilities. 5-Always
Applies knowledge of MOU and policies/procedures effectively within the department.	Applies knowledge of MOU and policies/procedures effectively within the department. 1-Never	Applies knowledge of MOU and policies/procedures effectively within the department. 2-Rarely	Applies knowledge of MOU and policies/procedures effectively within the department. 3-Sometimes	Applies knowledge of MOU and policies/procedures effectively within the department. 4-Most of the time	Applies knowledge of MOU and policies/procedures effectively within the department. 5-Always

TEAMWORK:

	1-Never	2-Rarely	3-Sometimes	4-Most of the time	5-Always
Fosters a supportive work environment.	*TEAMWORK: Fosters a supportive work environment. 1-Never	Fosters a supportive work environment. 2-Rarely	Fosters a supportive work environment. 3-Sometimes	Fosters a supportive work environment. 4-Most of the time	Fosters a supportive work environment. 5-Always
Uses collaboration in problem-solving.	Uses collaboration in problem-solving. 1-Never	Uses collaboration in problem-solving. 2-Rarely	Uses collaboration in problem-solving. 3-Sometimes	Uses collaboration in problem-solving. 4-Most of the time	Uses collaboration in problem-solving. 5-Always
Shares information and resources.	Shares information and resources. 1-Never	Shares information and resources. 2-Rarely	Shares information and resources. 3-Sometimes	Shares information and resources. 4-Most of the time	Shares information and resources. 5-Always
Encourages and accepts suggestions to improve the efficiency and effectiveness of the work unit.	Encourages and accepts suggestions to improve the efficiency and effectiveness of the work unit. 1-Never	Encourages and accepts suggestions to improve the efficiency and effectiveness of the work unit. 2-Rarely	Encourages and accepts suggestions to improve the efficiency and effectiveness of the work unit. 3-Sometimes	Encourages and accepts suggestions to improve the efficiency and effectiveness of the work unit. 4-Most of the time	Encourages and accepts suggestions to improve the efficiency and effectiveness of the work unit. 5-Always
Establishes Professional Practice Groups (PPGs) to involve RN input.	Establishes Professional Practice Groups (PPGs) to involve RN input. 1-Never	Establishes Professional Practice Groups (PPGs) to involve RN input. 2-Rarely	Establishes Professional Practice Groups (PPGs) to involve RN input. 3-Sometimes	Establishes Professional Practice Groups (PPGs) to involve RN input. 4-Most of the time	Establishes Professional Practice Groups (PPGs) to involve RN input. 5-Always

COMMENTS:

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Supervisory Performance EvaluationExit this evaluation form