PERFORMANCE APPRAISAL – OR TECHNICIAN

NAME: PERFORMANCE REVIEW DATE:

SCALE 1 = OUTSTANDING 2 = HIGHLY EFFECTIVE 3 = EFFECTIVE 4 = IMPROVEMENT NEEDED 5 = UNACCEPTABLE

RESPONSIBILITIES	RATING	COMMENTS
1. Practice according to the philosophy, standard and policies as established by the Department of Nursing Service.
2. Demonstrate knowledge of policies and procedures regarding: fire/safety regulations, code blue, disaster plan, infection control.
3. Comply with policies and procedures related to attendance and lateness.
4. Contribute to the maintenance of adequate unit staffing by accepting reassignment and rotating tours of duty.
5. Support unit, corporate and departmental objectives.
6. Support cost containment efforts through effective clinical practice.
7. Maintain daily inventory control and replenish supplies for subsequent days use.
8. Transport clients.
9. Maintain cleanliness, safety and efficiency of the operating room.
10. Helps move or position clients.
11. Assemble supplies for surgical procedures.
12. Operate tables, lights, suction equipment, electrosurgical units and diagnostic equipment safely and effectively.
13. Autoclave equipment.
14. Wash table and other operating room furniture after each procedure.
15. Select instruments for cases scheduled for the following days.
16. Sets up operative field in accordance with the type of surgery to be performed.
17. Passes instruments during surgery, recognizing and interpreting the immediate situation to anticipate the surgeons needs.
18. Help drape the patient in accordance with the operation to be performed.
19. Count instruments, sponges and needles with the Circulating Nurse.
20. Assists in application of casts and splints.
22. Performs pre-operative skin prep using sterile techniques.
23. Take lunch and breaks as assigned.
24. Perform tasks and duties other than assigned according to the needs of the department.
RESPONSIBILITIES	RATING	COMMENTS
25. Demonstrate organizational skills when completing assignments, seeking guidance as needed from the Registered Professional Nurse.
26. Recognize the cultural backgrounds and spiritual needs and respect the religious beliefs of individual clients/significant others.
27. Report any malfunctioning equipment to nurse manager or charge nurse.
28. Report to clinical manager and/or charge nurse when leaving the department.
29. Communicate in a courteous, sensitive manner.
30. Use appropriate channels of communication with client and/or significant other, nursing staff and other health team members.
31. Communicate information concerning client status to the Circulating Nurse.
23. Attend all mandatory inservice programs.
32. Participate in orientation of new personnel as directed by the RN.
33. Complete self-evaluation and define individual goals and objectives

ACCOMPLISHMENTS DURING REVIEW PERIOD: GOALS FOR NEXT REVIEW PERIOD:

EMPLOYEE COMMENTS:

Evaluator: Title: Date:

Employee: Location: Date: