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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)
Practice Name
Your Name
(Required)
First
Last
Your Email
(Required)
Locums Name
First
Last
Date Locum Employed from
(Required)
DD slash MM slash YYYY
Date Locum Employed to
(Required)
DD slash MM slash YYYY
Did the practice provide a thorough orientation at the beginning of the placement?
Yes
No
Comment
Did the locum adjust well to the practice processes and protocols?
Yes
No
Comment
Did the locum adapt well to the practice environment?
Yes
No
Comment
Did the locum work well with other GPs?
Yes
No
Comment
Did the locum work well nurses and admin staff?
Yes
No
Comment
How would you rate the locum on the following:
Clinical skills
Poor
Adequate
Good
Excellent
Patient notes
Poor
Adequate
Good
Excellent
Approachability/friendliness
Poor
Adequate
Good
Excellent
Ability to work as part of a team
Poor
Adequate
Good
Excellent
Cultural competency
Poor
Adequate
Good
Excellent
Comment on above if ‘Poor’ is selected and any information we may need to be made aware of
How many patients did the locum see a day?
Were they able to keep up with the workload?
Yes
No
Comment
Would you recommend this locum to colleagues?
Yes
No
Comment
How could NZLocums & NZMedJobs have improved our service throughout this placement?
Any other comments not covered above
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?
Yes
No
Do you give your permission to release the information in this report to third parties should this be requested by the locum?
Yes
No
Signature (please type your name)
Date
MM slash DD slash YYYY
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