Instructor Assessment Form

Participant Scoring

Portal Access

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More Info

Going to miss a shift?

A form to assess the professionalism, behaviors, and skills of instructors.

Clinician(Required)

Name of Participant(Required)

First Last

Participant's Email Address

Date(Required)

MM slash DD slash YYYY

1 - Elements were not observed or not present.
2 - Elements are beginning to appear.
3 - Elements appear, but not with consistency.
4 - Elements appear regularly at a satisfactory level.
5 - Elements appear frequently, above required level.
6 - Elements appear continuously, at a superior level

Safety & Decision Making(Required)

Professionalism(Required)

People Skills(Required)

Teaching Skills(Required)

Technical Skills(Required)

Red Flag(Required)

Yes, this instructor needs more support

No, this instructor is ready to teach

Red Flag(Required)

Please add notes regarding the support this instructor needs prior to teaching

Notes

Please add any general notes regarding this instructors skills, decisions, or behaviors.

Password

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