CMH EMS Student Behavior Evaluation Form
Please rate the student according to the statements below. WHILE SCORING, PLEASE KEEP IN MIND THE STUDENT'S WORST PERFORMANCE, not the average or best performance.
Assessor's name *
Student's name *
Assessment date *
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POSITIVE is being proud of who we are and proud of what we do by communicating with key words at key times (i.e. AIDET), taking pride in personal and facility appearance, and interacting with others professionally with smiles and kind words.
The student is POSITIVE *
Strongly disagree
Strongly agree
RESPECTFUL is treating everyone as a friend or family by respecting other's time, being sensitive to emotions, and communicating respectfully with words, tone, and body language.
The student is RESPECTFUL *
Strongly disagree
Strongly agree
INNOVATIVE is encouraging new ideas and embracing change by seeking opportunities to be effective, efficient, and safe in providing high quality care, supporting advanced technology, and taking ownership of the team approach.
The student is INNOVATIVE *
Strongly disagree
Strongly agree
DEDICATED is committing ourselves to improving the quality of life by taking personal responsibility and accountability, being fully engaged, and being determined to exceed expectations.
The student is DEDICATED *
Strongly disagree
Strongly agree
EMPOWERED is taking pride in knowing what to do and how it makes a difference by just fixing it or making it better, being proactive on behalf of others, and encouraging our peers to be accountable.
The student is EMPOWERED *
Strongly disagree
Strongly agree
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