Title Page
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Department
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Employee Name (To be evaluated)
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Date and Time of Review
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Employee providing feedback (Optional)
General Question
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Is your coworker always gets in on-time at work?
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Is your coworker hardworking?
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Does your coworker possess a positive impact on your environment?
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Does your coworker meet his/her deadlines?
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Does your coworker give attention to details?
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Do you trust your coworker's decision?
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Is your coworker willing to admit mistakes?
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Does your coworker take responsibility for his/her mistakes?
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Does your coworker communicate well with others?
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Is your coworker willing to adjust on changing priorities?
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Does your coworker behave professionally?
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Does your coworker collaborate well with others?
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Is your coworker effective on his/her job?
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Does your coworker treat you with respect?
Assessment
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How do the duties/services performed by this employee interface/interact with your department?
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How do you describe this employee’s ability to work with you and others within your department?
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How receptive is this employee to your requests?
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How would you describe this employee’s personal communication and behavior when interacting with you or your department?
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What recommendations do you have that would assist us in strengthening this working relationship?
Completion
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Evaluated Employee (Full Name and Signature)
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Supervisor (Full Name and Signature)