Field Staff's Feedback Form Date: ______ / ______ / __________ Field Staff's Feedback Form Date: ______ / ______

_ / __________ Field Staff's Feedback Form Date: ______ / ______ / __________

Name of Ratee:___________________________________________________________________________________________ Name of Ratee:___________________________________________________________________________________________

Service/s Provided:_________________________________________________________________________________________ Service/s Provided:_________________________________________________________________________________________

Kindly rate our services Kindly rate our services

(Please put "P " under the (Please put "P " under the
appropriate column. Performance Performance
Performance met Performance failed
Performance was appropriate column. Performance Performance
Performance met Performance failed
Performance was
represents an exceeded consistently below represents an exceeded consistently below
Thank you.) expectations to meet expectations Thank you.) expectations to meet expectations
extraordinary level expectations expectations extraordinary level expectations expectations
1. Quality 1. Quality
(Effectiveness relates to getting (Effectiveness relates to getting
the right things done) the right things done)
2. Efficiency 2. Efficiency
(Accomplished with a minimum (Accomplished with a minimum
amount or quantity of waste, amount or quantity of waste,
expenses, or unnecessary effort) expenses, or unnecessary effort)
3. Timeliness 3. Timeliness
(finished within the scheduled or (finished within the scheduled or
expected time frame) expected time frame)
Note: After completing the feedback form, kindly return it to the ratee's supervisor. Note: After completing the feedback form, kindly return it to the ratee's supervisor.

Assessed by:_____________________________________________ Assessed by:_____________________________________________

Signature over printed name Signature over printed name

Field Staff's Feedback Form Date: ______ / ______ / __________ Field Staff's Feedback Form Date: ______ / ______ / __________

Name of Ratee:___________________________________________________________________________________________ Name of Ratee:___________________________________________________________________________________________

Service/s Provided:_________________________________________________________________________________________ Service/s Provided:_________________________________________________________________________________________

Kindly rate our services Kindly rate our services

(Please put "P " under the (Please put "P " under the
appropriate column. Performance Performance
Performance met Performance failed
Performance was appropriate column. Performance Performance
Performance met Performance failed
Performance was
represents an exceeded consistently below represents an exceeded consistently below
Thank you.) expectations to meet expectations Thank you.) expectations to meet expectations
extraordinary level expectations expectations extraordinary level expectations expectations
1. Quality 1. Quality
(Effectiveness relates to getting (Effectiveness relates to getting
the right things done) the right things done)
2. Efficiency 2. Efficiency
(Accomplished with a minimum (Accomplished with a minimum
amount or quantity of waste, amount or quantity of waste,
expenses, or unnecessary effort) expenses, or unnecessary effort)
3. Timeliness 3. Timeliness
(finished within the scheduled or (finished within the scheduled or
expected time frame) expected time frame)
Note: After completing the feedback form, kindly return it to the ratee's supervisor. Note: After completing the feedback form, kindly return it to the ratee's supervisor.

Assessed by:_____________________________________________ Assessed by:_____________________________________________

Signature over printed name Signature over printed name