Clinical & Professional Feedback

An essential component of professional development includes periodic clinical and/or professional feedback. This feedback facilitates communication, provides useful information about job performance, enhances better working relationships, and provides a historical record of performance. Please use the following criteria in providing feedback for the employee. Your time and comments are very much appreciated by AMS as we strive to maintain the highest standards of practice and comply with TJC Health Care Staffing certification requirements. This feedback is confidential and will be submitted securely directly to the AMS office. Nurse Manager / Clinical Supervisor: Please complete the following:

"*" indicates required fields

Your Name*

Applicant Information

Employee Name for whom you are providing feedback*
Was this employee Agency or Staff?*
Was this employee Part or Full Time?*
MM slash DD slash YYYY
MM slash DD slash YYYY

Professional Behaviors

If any of the below areas are not applicable, please select "meets standards" and include a comment that the area was not applicable
Clinical Competence & Judgment
Flexibility & Adaptability
Time Management
Utilization of Electronic Medical Records
Attitude & Cooperation
Attendance & Punctuality
Is this employee eligible to return to your facility / hospital?
If you are unable to complete this form due to HR policy, please check the following box:
By entering your name electronically you agree that this information is correct to the best of your knowledge.