PERFORMANCE APPRAISAL

RADIOLOGY TECHNOLOGIST

Name: Date: ___________

Clinical Location:

Please complete the following evaluation on the above named employee. Thank you for your assistance in the evaluation process.

Technical position held in your facility:

RT	Mammography	CT	MRI
Special Procedures	Radiation Therapy	Nuclear Medicine	General Ultrasound
P/V Ultrasound	Echocardiography	Cardiac Cath	Dosimetry

Performance Evaluation	Outstanding	Highly Effective	Effective	Improvement Needed	Unacceptable
Quality of Work
Quantity of Work
Attitude
Professional Conduct
Adaptability to Work Situations
Dependability
Cooperation
Ability to Get Along With Others
Ability to Accept Leadership Role
Attendance and Punctuality
Personal Appearance

Please provide additional comments and goals for the next year on reverse side.

Evaluator’s Signature: Date:

Title: Facility:

Employee Signature: Date: ______________