NAME: MICHELLE LAZARO

DIALYSIS CENTER: CMGH RENAL CENTER

NURSE ASSISTANT EVALUATION

TOOL
CRITERIA 5 4 3 2 1 COMMENTS
ATTITUDE

1. Demonstrate proper grooming

2. Reports duty on time.

3. Good communication between
patients and nurses
4. Observe proficiency in handling
patients
5. Addressing employee by names not
on alias.
NO ACTIVITIES YET
6. Attend on company activities.

7. Demonstrates workplace etiquette.

8. Establishes rapport; builds and
maintains effective working
relationships.
9. Practice attentive and active listening.
10. Maintains cooperative working
relationship.
11. Promotes positive image.
12. Demonstrates willingness to perform
unassigned task when needed.
13. Demonstrates initiative in taking
charge of new assignment and task.
14. Accepts changes/innovation willingly.
15. Responses positively to constructive
critism.
16. Greets all the staff in the center.
17. Provides good care/service for the
patients.
UNIFORM/ GROOMING

18. Wears uniform according to date.

19. Wears shoes while on duty.

20. Comes to work properly groomed.

 COMPLIANCE

5 4 3 2 1 COMMENTS

21. Uses time effectively and stays

focused to ensure work is completed.
22. Determines tasks and secures
appropriate resources to
get things done
JOB KNOWLEDGE
23. Do vital signs accurately
24. Assess patient appropriately
25. Maintains effective performance
under pressure.
26. Copes effectively and develops
effective approach to deal with
pressure or stress.
TOTAL SCORE 96.15
TOTAL SCORE AS
PERCENTAGE=TOTAL
SCORE/130X100
Recommendation/ for improvement:

She still stood out among the caregivers that we have in the center. Consistent in everything
that she does. STILL She can work efficiently and effectively.
 NAME: JONAR MANGUNAY
DIALYSIS CENTER: CMGH RENAL CENTER

NURSE ASSISTANT EVALUATION

TOOL
CRITERIA 5 4 3 2 1 COMMENTS
ATTITUDE

27. Demonstrate proper grooming

28. Reports duty on time.

29. Good communication between
patients and nurses
30. Observe proficiency in handling
patients
31. Addressing employee by names not
on alias.
NO EVENTS TO ATTEND AS OF
32. Attend on company activities. THE MOMENT

33. Demonstrates workplace etiquette.

34. Establishes rapport; builds and
maintains effective working
relationships.
35. Practice attentive and active listening.
36. Maintains cooperative working
relationship.
37. Promotes positive image.
38. Demonstrates willingness to perform
unassigned task when needed.
39. Demonstrates initiative in taking
charge of new assignment and task.
40. Accepts changes/innovation willingly.
41. Responses positively to constructive
critism.
42. Greets all the staff in the center.
43. Provides good care/service for the
patients.
UNIFORM/ GROOMING

44. Wears uniform according to date.

 45. Wears shoes while on duty.

46. Comes to work properly groomed.

COMPLIANCE

5 4 3 2 1 COMMENTS

47. Uses time effectively and stays

focused to ensure work is completed.
48. Determines tasks and secures
appropriate resources to
get things done
JOB KNOWLEDGE
49. Do vital signs accurately
50. Assess patient appropriately
51. Maintains effective performance
under pressure.
52. Copes effectively and develops
effective approach to deal with
pressure or stress.
TOTAL SCORE 91.53
TOTAL SCORE AS
PERCENTAGE=TOTAL
SCORE/130X100
Recommendation/ for improvement:

We can see improvement from him, we STILL need to remind him on something that he needs to be done
like: logbooks etc. ALREADY SAW SOME IMPROVEMENTS LIKE: NO GREEN JOKES IF NECESSARY
 NAME: Lorrielle Concepcion
DIALYSIS CENTER: CMGH RENAL CENTER

NURSE ASSISTANT EVALUATION

TOOL
CRITERIA 5 4 3 2 1 COMMENTS
ATTITUDE

53. Demonstrate proper grooming

54. Reports duty on time.

55. Good communication between
patients and nurses
56. Observe proficiency in handling
patients
57. Addressing employee by names not
on alias.
NO EVENTS AS OF THE MOMENT
58. Attend on company activities.

59. Demonstrates workplace etiquette.

60. Establishes rapport; builds and
maintains effective working
relationships.
61. Practice attentive and active listening.
62. Maintains cooperative working
relationship.
63. Promotes positive image.
64. Demonstrates willingness to perform
unassigned task when needed.
65. Demonstrates initiative in taking
charge of new assignment and task.
66. Accepts changes/innovation willingly.
67. Responses positively to constructive
critism.
68. Greets all the staff in the center.
69. Provides good care/service for the
patients.
UNIFORM/ GROOMING

70. Wears uniform according to date.

 71. Wears shoes while on duty.

72. Comes to work properly groomed.

COMPLIANCE

5 4 3 2 1 COMMENTS

73. Uses time effectively and stays

focused to ensure work is completed.
74. Determines tasks and secures
appropriate resources to
get things done
JOB KNOWLEDGE
75. Do vital signs accurately
76. Assess patient appropriately
77. Maintains effective performance
under pressure.
78. Copes effectively and develops
effective approach to deal with
pressure or stress.
TOTAL SCORE 81.53
TOTAL SCORE AS
PERCENTAGE=TOTAL
SCORE/130X100
Recommendation/ for improvement:

All I can say is, THERE ARE SOME IMPROVEMENTS BUT WE NEED TO MAKE SURE THAT SHE CAN DO IT
MORE OFTEN
 NAME: HERBERT
DIALYSIS CENTER: CMGH RENAL CENTER

NURSE ASSISTANT EVALUATION

TOOL
CRITERIA 5 4 3 2 1 COMMENTS
ATTITUDE

79. Demonstrate proper grooming

ALWAYS ON TIME
80. Reports duty on time.
81. Good communication between
patients and nurses
BECAUSE OF WORK EXP
82. Observe proficiency in handling
patients ALREADY

UNDERSTANDABLE/ SINCE HE
83. Addressing employee by names not WAS THE LATEST ADDED
on alias. MEMBER OF THE TEAM

NO EVENTS AS OF THE MOMENT

84. Attend on company activities.

85. Demonstrates workplace etiquette.

86. Establishes rapport; builds and
maintains effective working
relationships.
87. Practice attentive and active listening.
88. Maintains cooperative working
relationship.
89. Promotes positive image.
90. Demonstrates willingness to perform
unassigned task when needed.
NO SPECIFIC TASK AS OF THE
91. Demonstrates initiative in taking
charge of new assignment and task. MOMENT

92. Accepts changes/innovation willingly.

93. Responses positively to constructive
critism.
94. Greets all the staff in the center.
95. Provides good care/service for the
patients.
UNIFORM/ GROOMING
NO UNIFORM BECAUSE OF
BEING A NEW MEMBER OF THE
96. Wears uniform according to date.
TEAM/ WILL WORKING ON IT

97. Wears shoes while on duty.

98. Comes to work properly groomed.

COMPLIANCE

5 4 3 2 1 COMMENTS

99. Uses time effectively and stays

focused to ensure work is completed.
100. Determines tasks and secures
appropriate resources to
get things done
JOB KNOWLEDGE
101. Do vital signs accurately
102. Assess patient appropriately
103.Maintains effective performance
under pressure.
104.Copes effectively and develops
effective approach to deal with
pressure or stress.
TOTAL SCORE 82.30
TOTAL SCORE AS
PERCENTAGE=TOTAL
SCORE/130X100
Recommendation/ for improvement:

SINCE HE WAS THE LATEST ADDED MEMBER OF THE TEAM, I CAN SAY THAT HE NEEDS SOME TIME TO
ADJUST TO THE NEW ENVIROMENT/ GOOD EFFORT FOR EVERYTHING SINCE HE HAS ALREADY AN
EXPERIENCE WORKING WITH THE PATIENT. WILL SEE SOME IMPROVEMENTS FROM HIM SINCE I CAN
SENSE A RESPONSIBLE PERSON FROM HIM