EmailMe Form - Pharmacy Technician Evaluation (NWC)

What is the Full Name of your Assistant? *

First Last

(Please enter the first and last name of your assistant, ex. John Smith)

What Campus does the Assistant Attend? *

How many Total Days did the Assistant Attend? *

(Please enter the number of total days attended, ex. 30)

How many Days was your Assistant Absent? *

(Please enter the number days absent, ex. 2)

How many Days was your Assistant Tardy? *

(Please enter the number of days tardy, ex. 1)

(PLEASE NOTE: A total of 280 hours is required.)

Practical Experience In:

Telephone Techniques *

Below Average

Average

Above Average

Excellent

Use of Pharmaceutical Abbreviations *

Below Average

Average

Above Average

Excellent

Use of Cash Register *

Below Average

Average

Above Average

Excellent

Knowledge of Trade/Generic Drug Names *

Below Average

Average

Above Average

Excellent

Computer Skills *

Below Average

Average

Above Average

Excellent

Knows Legal Requirements for Prescriptions *

Below Average

Average

Above Average

Excellent

Unit Dose Dispensing:

Speed *

Below Average

Average

Above Average

Excellent

Accuracy *

Below Average

Average

Above Average

Excellent

Proper Documentation *

Below Average

Average

Above Average

Excellent

Knowledge of Prepackaging & Compounding:

Measuring Techniques *

Below Average

Average

Above Average

Excellent

Compounding Techniques *

Below Average

Average

Above Average

Excellent

Labeling of Products *

Below Average

Average

Above Average

Excellent

Proper Documentation *

Below Average

Average

Above Average

Excellent

Preparation of IV Admixtures:

Organization *

Below Average

Average

Above Average

Excellent

Aseptic Technique *

Below Average

Average

Above Average

Excellent

Calculations *

Below Average

Average

Above Average

Excellent

Label Typing Skills:

Ability to Translate Abbreviations *

Below Average

Average

Above Average

Excellent

Knows the Required Information *

Below Average

Average

Above Average

Excellent

Accuracy *

Below Average

Average

Above Average

Excellent

Speed *

Below Average

Average

Above Average

Excellent

Use of Patient Profiles:

Knows Information on Profile *

Below Average

Average

Above Average

Excellent

How to Update Profile *

Below Average

Average

Above Average

Excellent

How to Retrieve Information *

Below Average

Average

Above Average

Excellent

Controlled Substances:

Knows the Legal Requirements *

Below Average

Average

Above Average

Excellent

Able to Maintain Accurate, Organized Records *

Below Average

Average

Above Average

Excellent

Knowledge of Ordering/Billing Procedures:

Knowledge of 3rd Party Billing *

Below Average

Average

Above Average

Excellent

Knows How to Look Up Drug Prices *

Below Average

Average

Above Average

Excellent

Knows How to Calculate Charges *

Below Average

Average

Above Average

Excellent

Knowledge of Receiving Procedures *

Below Average

Average

Above Average

Excellent

Knows Difference Between a Packing Slip & an Invoice *

Below Average

Average

Above Average

Excellent

Checking Items Received Against Invoices *

Below Average

Average

Above Average

Excellent

Personal Traits & Appearance:

Personal Appearance *

Below Average

Average

Above Average

Excellent

Personality *

Below Average

Average

Above Average

Excellent

Courtesy & Respect *

Below Average

Average

Above Average

Excellent

Alertness *

Below Average

Average

Above Average

Excellent

Cheerfulness *

Below Average

Average

Above Average

Excellent

Attention to Details *

Below Average

Average

Above Average

Excellent

Ability to Follow Orders *

Below Average

Average

Above Average

Excellent

Organizes Work *

Below Average

Average

Above Average

Excellent

Works Independently *

Below Average

Average

Above Average

Excellent

Rapport with Patients *

Below Average

Average

Above Average

Excellent

Sincere Interest in Pharmacy *

Below Average

Average

Above Average

Excellent

General Comments:

(If you have any other comments please leave them in this box)

Name of Hospital/Pharmacy: *

(Please enter the name of your hospital or pharmacy)

Your Name: *

Prefix First Last Suffix

(Please enter your name, ex. Dr. James Brown)

Your E-Mail Address: *

(Please enter your e-mail address)

Your Telephone Number: *

### - ### - ####

(Please enter your telephone number)