Performance Review Template for Nurses

PERFORMANCE EVALUATION: NURSING PERSONNEL

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I. GENERAL INFORMATION

Employee Name: [________________________________]
Employee ID: [________________________________]
Job Title: [________________________________]
Department/Unit: [________________________________]
Evaluation Period: From [____/____/____] to [____/____/____]
Reviewer Name/Title: [________________________________]
Date of Review: [____/____/____]

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II. PERFORMANCE RATING SCALE

• 5 – Exceptional: Performance consistently exceeds expectations; demonstrates mastery and leadership.
• 4 – Exceeds Expectations: Performance frequently exceeds requirements; consistently high quality.
• 3 – Meets Expectations: Performance consistently meets requirements; reliable and competent.
• 2 – Needs Improvement: Performance occasionally falls below requirements; requires corrective action.
• 1 – Unsatisfactory: Performance consistently fails to meet core competencies; immediate intervention required.

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III. CORE COMPETENCIES EVALUATION

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IV. NARRATIVE ASSESSMENT

Summary of Achievements:
[__________________________________________________________________________]
[__________________________________________________________________________]

Areas for Development/Growth:
[__________________________________________________________________________]
[__________________________________________________________________________]

Progress Toward Previous Goals:
[__________________________________________________________________________]
[__________________________________________________________________________]

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V. GOAL SETTING (UPCOMING REVIEW PERIOD)

• Goal 1: [______________________________________________________________]
• Goal 2: [______________________________________________________________]
• Goal 3: [______________________________________________________________]

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VI. EMPLOYEE COMMENTS

The employee may provide comments regarding the evaluation process or their performance.
[__________________________________________________________________________]
[__________________________________________________________________________]

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VII. SIGNATURE AND ACKNOWLEDGMENT

By signing below, the parties acknowledge that this performance evaluation has been discussed. The employee’s signature does not necessarily indicate agreement with the contents, but acknowledges that the evaluation has been reviewed.

Evaluator Signature:

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Date: [____/____/____]

Employee Signature:

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Date: [____/____/____]

Department Head/HR Representative:

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Date: [____/____/____]