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Practice Evaluation of Locum

To help improve the service we provide, please rate your experience of your placement below.

Practice Name(Required)
Your Name(Required)
Locums Name

Did the practice provide a thorough orientation at the beginning of the placement?
Did the locum adjust well to the practice processes and protocols?
Did the locum adapt well to the practice environment?
Did the locum work well with other GPs?
Did the locum work well nurses and admin staff?

How would you rate the locum on the following:

Clinical skills
Patient notes
Approachability/friendliness
Ability to work as part of a team
Cultural competency
Were they able to keep up with the workload?
Would you recommend this locum to colleagues?

CONFIDENTIALITY & PRIVACY

The Privacy Act (1993) requires that I ask you the following questions.
Although the information in this evaluation report is not automatically released to the locum, do you give your permission to release the information in this report to the locum if requested?
Do you give your permission to release the information in this report to third parties should this be requested by the locum?