Appraisal | Total Assist

Appraisal Form

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Department

Applicant Name(Required)

First Last

Professional Registration Number(Required)

Have you been appraised within the last 12 months?(Required)

Yes

Name of Appraiser(Required)

First Last

In order to work within the NHS you will need to be appraised annually by a Senior Practitioner of the same discipline, this person will become your “appraiser”. Please give the details of the Senior Practitioner you have made arrangements with to act as your appraiser.

Position and Grade of Appraiser(Required)

Professional Registration Number of Appraiser(Required)

Date of appraisal(Required)

Date next appraisal due(Required)

Appraisal Statement - Select if you agree with the following statements(Required)

I confirm the appraisal was within an "Approved NHS Appraisal System" and includes 360 degree feedback as well as feedback from patients.

I confirm that I maintain a written portfolio of my professional experience and attendance at proffessional development courses, which also includes a written and agreed "Personal Development Plan" as agreed at the appraisal.

Signature(Required)

Date(Required)