Staff Quality Review

Strictly Confidential

At Key Care & Support, we prioritise your feedback as a vital component of our continuous improvement programme. We kindly ask you to spare a few moments to complete this short Staff Quality Review, enabling us to enhance your experience with our services. Your input is essential for us to assess and improve what we provide.

Name of the person we support

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Support Staff Details

Name

Date and time of shift

Date

Time

Please score (1 = Very poor 2 = Poor 3 = Good 4 = Very good 5 = excellent)

General appearance for duty

Very Poor	Poor	Average	Good	Excellent
Very PoorPurchase Very Poor	PoorPurchase Poor	AveragePurchase Average	GoodPurchase Good	ExcellentPurchase Excellent

Comments

Timekeeping

Very Poor	Poor	Average	Good	Excellent
Very PoorPurchase Very Poor	PoorPurchase Poor	AveragePurchase Average	GoodPurchase Good	ExcellentPurchase Excellent

Comments

Communication skills

Very Poor	Poor	Average	Good	Excellent
Very PoorPurchase Very Poor	PoorPurchase Poor	AveragePurchase Average	GoodPurchase Good	ExcellentPurchase Excellent

Comments

Record keeping skills

Very Poor	Poor	Average	Good	Excellent
Very PoorPurchase Very Poor	PoorPurchase Poor	AveragePurchase Average	GoodPurchase Good	ExcellentPurchase Excellent

Comments

Ability to work in a team

Very Poor	Poor	Average	Good	Excellent
Very PoorPurchase Very Poor	PoorPurchase Poor	AveragePurchase Average	GoodPurchase Good	ExcellentPurchase Excellent

Comments

Initiative and motivation

Very Poor	Poor	Average	Good	Excellent
Very PoorPurchase Very Poor	PoorPurchase Poor	AveragePurchase Average	GoodPurchase Good	ExcellentPurchase Excellent

Comments

Clinical skills

Very Poor	Poor	Average	Good	Excellent
Very PoorPurchase Very Poor	PoorPurchase Poor	AveragePurchase Average	GoodPurchase Good	ExcellentPurchase Excellent

Comments

Attitude to work placement

Very Poor	Poor	Average	Good	Excellent
Very PoorPurchase Very Poor	PoorPurchase Poor	AveragePurchase Average	GoodPurchase Good	ExcellentPurchase Excellent

Comments

Time management

Very Poor	Poor	Average	Good	Excellent
Very PoorPurchase Very Poor	PoorPurchase Poor	AveragePurchase Average	GoodPurchase Good	ExcellentPurchase Excellent

Details Please Poor

Comments

Please add any additional comments

Signature

Clear Signature

Declaration I confirm that the information I have given is a true reflection of the applicants’ abilities and potential to fulfil the assignment