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* 1. Preceptor (Your) Full Name:

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* 2. New Hire's Full Name:

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* 3. Punctuality

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* 4. Stayed full amount of allotted time for client

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* 5. Uses 2 factor authentication

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* 6. Checks and responds to voicemail

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* 7. Reliably does assigned tasks

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* 8. Logs in/out with mobile phone

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* 9. Understands and follows directions

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* 10. Consistently wears Circle of Care ID

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* 11. Wears proper worker attire/footwear

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* 12. Has appropriate level of conversation with client/family

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* 13. Shows an understanding of professional boundaries

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* 14. Respectful of colleagues and clients

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* 15. Reports concerns effectively to the office (NFV, Refused Visit, etc.)

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* 16. Seeks and responds to guidance

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* 17. Shows interest and initiative

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* 18. Is client-centered at all times; Uses Service with Heart

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* 19. Provides a safe environment for client

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* 20. Adheres to Circle of Care policies and procedures

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* 21. Communicates with client clearly during personal care

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* 22. Asks critical care questions

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* 23. Showed appropriate involvement of family members or colleagues during care

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* 24. Followed the care plan

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* 25. Cleaned and tidied bathroom/kitchen after use

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* 26. How well were the duties performed

  Poor Fair Good Excellent N/A
toileting & incontinence products
dressing client
personal hygiene (hair care, mouth care, shaving – electric razor only)
laundry
meal/preparation
medication reminder
shower/sponge bath
light cleaning

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* 27. Additional Comments:

T