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Embed code for: Peer Feedback form, Koles, July-Dec 2015 (1)
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Colleague you are evaluating: _______________________________________
Your name (evaluator): ____________________________________________
Period of Evaluation: July–December, 2015 (term one, year 2)
Part One: Quantitative Assessment (check ONLY one Box for each of these 12 ITEMS)
Cooperative Learning Skills: Never Sometimes Often Always Arrives on time and remains with team during activities Demonstrates a good balance of active listening and speaking Asks useful or probing questions Shares knowledge generously Self-Directed Learning: Never Sometimes Often Always Is well prepared for team activities Shows appropriate depth of knowledge Identifies limits of personal knowledge Is able to explain things clearly to teammates Interpersonal Skills: Never Sometimes Often Always Gives useful and meaningful feedback to others Accepts useful and meaningful feedback from others Is able to listen and understand what others are saying Shows respect for the opinions and feelings of others
Part TWO: Qualitative Assessment
(For each item, write at least one sentence, but not more than three sentences)
1) What is the single most valuable contribution this person makes to your team?
2) What is the single most important way this person could adjust their behavior to more effectively help your team?
Revised December, 2015 / P. Koles, MD