LPM VOLUNTEER EVALUATION FORM

Volunteer’s Name:__________________________________________________

Volunteer Position:__________________ Supervisor: ______________________

Evaluation Period: _______ to ________ Date of Evaluation: _________________

Which of the following personal qualities has the volunteer shown (please check if applicable)

Punctual circle Takes initiative circle
Organized circle Honest circle
Responsible circle Enthusiastic circle
Cooperative circle Respects confidentiality circle
Flexible circle Attentive to details circle
Patient circle Friendly circle

boxHow would you rate the volunteer’s success in the following skills?

  Often Successful Occasionally Successful Seldom Successful
Ability to perform tasks assigned      
Ability to follow instructions      
Ability to ask questions to get necessary information      

box Areas for improvement:
        ___________________________________________________________

boxAreas where LPM will help the volunteer improve:
        ___________________________________________________________

Need for additional training: circleYes circleNo

Please list:_______________________________________________________________

Suggestions for changes to volunteer job description: ________________________________________________________________________

________________________________________________________________________

Is volunteer willing to continue in this position? circleYes circleNo

Supervisor’s comments (general feedback on communication skills, leadership abilities if relevant, etc):

________________________________________________________________________

________________________________________________________________________

Volunteer’s Comments:

________________________________________________________________________

________________________________________________________________________

Supervisor’s signature:____________________________________________________

Volunteer’s Signature: ____________________________________________________

Signing this document indicates that the information on this form has been reviewed with the volunteer, but does not necessarily mean that both parties agree on the evaluation.


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