360 Appraisal

For my Appraisal this year I have decided to be brave and undergo a 360 appraisal.

This involves asking members of the surgery staff ( doctors / nurses/receptionists/admin etc ) to anonymously answer some simple questions that are listed below.

If you receive this questionnaire please complete as honestly as you can and then return the form directly to ……………. who will type the replies so that when I see them I will not be able to recognise the handwriting!

The purpose of this is to see where I can improve my performance as a doctor and team member.

Thanking you for your honesty

Below are 10 questions and some boxes to tick from very bad to excellent.

1)  Does he communicate well with staff and colleagues?

Poorly / Can improve / ok / Good / Excellent

2)  Does he make patients feel at ease?

Poorly / Can improve / ok / Good / Excellent

3)  Does he dress appropriately?

Poorly / Can improve / ok / Good / Excellent

4)  Does he manage time well?

Poorly / Can improve / ok / Good / Excellent

5)  Does he manage stress well?

Poorly / Can improve / ok / Good / Excellent

6)  Does he appreciate the work others do?

Poorly / Can improve / ok / Good / Excellent

7)  Does he support work colleagues?

Poorly / Can improve / ok / Good / Excellent

8)  Is he punctual?

Poorly / Can improve / ok / Good / Excellent

9)  Does he make himself easily available for tasks?

Poorly / Can improve / ok / Good / Excellent

10) Does he complete his work load on time ?

Poorly / Can improve / ok / Good / Excellent

Please could you also complete three questions overleaf

Design: Dr Mark Tomson, Blackthorn Health Centre, Satchell Lane, Hamble SO31 4NQ, 02380453110

What do I do well?

In which ways could I improve?

Do you think that there are other questions I should be asking about myself?

Design: Dr Mark Tomson, Blackthorn Health Centre, Satchell Lane, Hamble SO31 4NQ, 02380453110