Candidate Name: ___________________________
Position Applied For: _______________________
Interviewer Name: __________________________
Date: ________________
Use this grid to evaluate the candidate’s clinical skills, experience, and overall competency. Score each area on a scale of 1–5:
1 – Needs Improvement | 2 – Below Average | 3 – Meets Expectations | 4 – Above Average | 5 – Excellent
| Skill | Description / Task | Score (1–5) | Notes / Observations |
|---|---|---|---|
| Patient Assessment | Vital signs, physical exam, history taking | ||
| Medication Administration | Accuracy, safety, dosage | ||
| IV / Infusion Skills | Insertion, monitoring, troubleshooting | ||
| Wound Care / Dressing | Proper technique, hygiene, documentation | ||
| Emergency Response | Rapid recognition & intervention | ||
| Equipment Operation | Ventilators, monitors, infusion pumps | ||
| Infection Control | Hand hygiene, PPE, isolation procedures | ||
| Specialty Procedures | Role-specific tasks (ICU, ER, Pediatrics, etc.) | ||
| Documentation | Accuracy, timeliness, clarity | ||
| Patient Communication | Explaining care, empathy, rapport |
| Competency Area | Description | Score (1–5) | Notes / Observations |
|---|---|---|---|
| Problem Solving | Ability to analyze situations and act appropriately | ||
| Teamwork | Collaborates effectively with colleagues and supervisors | ||
| Adaptability | Adjusts to changing conditions and priorities | ||
| Stress Management | Handles high-pressure situations calmly | ||
| Patient Advocacy | Protects patient interests and safety | ||
| Professionalism | Ethical behavior, punctuality, demeanor |
| Category | Score (1–5) | Comments / Recommendation |
|---|---|---|
| Clinical Skills | ||
| Behavioral / Situational Competency | ||
| Overall Recommendation |
Interviewer Signature: _______________________
This sheet works for RNs, LPNs, CNAs, and specialized nurses (ICU, ER, Pediatrics, Oncology, etc.) by just adjusting the “Specialty Procedures” row to the specific role.