Locum Evaluation of Placement

Full Name*

Practice name:*

Dates worked From:*

to:*

Email*

1. Did the practice provide a thorough orientation at the beginning of your placement?

Yes
No

Comment

2. Did the practice provide you with a practice profile?

Yes
No

Comment

3. Did the practice prepare you to deliver culturally appropriate services to the patients at the practice?

Yes
No

Comment

4. Did you feel welcomed and well supported in your first weeks at the practice?

Yes
No

Comment

5. How adequate was the practice in the following areas? Please rate your experience by selecting the most relevant category.

Practice process and protocols

Poor
Adequate
Good
Excellent

Computer system and notes

Poor
Adequate
Good
Excellent

6. How well was the practice set up to support Maori patients and other ethnic groups?

Poor
Adequate
Good
Excellent

7. How well were you supported by the practice GPs?

Poor
Adequate
Good
Excellent

8. How well were you supported by other practice staff?

Poor
Adequate
Good
Excellent

Comment on above if ‘Poor’ is selected and any information we may need to be made aware of.

9. Were you asked to undertake any work that was not agreed to in your contract?

Yes
No

Comment

10. How many patients did you see a day?

11. Did you feel the workload was manageable?

Yes
No

Comment

12. Did the provided accommodation meet your expectations?

Yes
No

Comment

13. Did the practice provide you with a vehicle of an appropriate standard?

Yes
No

Comment

14. Would you recommend this practice to other locums?

Yes
No

Comment

If you would like to provide a testimonial about this practice, please do so here (optional). By doing so you give your consent for us to share this via our marketing literature.

How could NZLocums have improved our services?

Any other comments not covered above.

CONFIDENTIALITY & PRIVACY
The Privacy Act (1993) requires that I ask you the following questions.

Although the information in this evaluation report is not automatically released to the practice, do you give your permission to release the information in this report to the practice if requested?

Yes
No

Do you give your permission to release the information in this report to third parties should this be requested by the practice?

Yes
No

Signature

Date

	PO Box 547 Wellington 6140
	Level 2, 88 The Terrace Wellington 6011 New Zealand