URDANETA CITY UNIVERSITY

(formerly City Colleges of Urdaneta)

San Vicente West, Urdaneta City, Philippines-2428
COLLEGE OF NURSING

PERFORMANCE RATING FORM FOR STUDENT HEADNURSING

Name:___________________________
Area:____________________________
Shift:____________________________

Percent Required Actual Performance

I. Personality 20%

1. Appearance 5% _____________
2. Courtesy 5% _____________
3. Health & emotional
stability 5% _____________
4. Integrity & honesty 5% _____________

II. Skills in Nursing 70%

1. Quality of work 15% ______________

2. Dependability, Attendance
& Punctuality 5% ______________
3. Communication (Oral
& Written) 10% ______________
4. Leadership 10% ______________
5. Relationship with
patient 10% ______________
6. Relationship with
Co-workers 10% ______________
7. Care of Hospital Equip.
And Records 10% ______________

III. Attitude to Supervision 10%

1. Criticism 3% ______________
2. Cooperation & interest 4% ______________
3. Confidence 3% ______________

IV. Total Percent 100% Rating: ______________

V. Remarks

__________________________ __________________________
HEADNURSE NURSE SUPERVISOR

_________________________ ZOSIMA C. GARIN

CHIEF NURSE DEAN, COLLEGE OF NURSING