Healthcare Worker Performance Self-Assessment
Name
Role / Position
Department / Unit
Date
Core Competencies
Competency Area
Self-Rating (1-5)
Comments
Clinical Skills
1
2
3
4
5
Communication
1
2
3
4
5
Teamwork
1
2
3
4
5
Professionalism & Ethics
1
2
3
4
5
Time Management
1
2
3
4
5
Strengths
Describe your key strengths
Areas for Improvement
Identify areas where you can improve
Goals
Set two or three goals for your professional development
Additional Comments
Add any other thoughts or feedback