EMPLOYER SURVEY for Graduates of Surgical Technology Education


ST Program


Place of Employment


Name of Graduate


Length of Employment


Part 1 Key: 5 = Exceeds Expectations, 4 = Often Exceeds Expectations, 3 = Regularly Meets Expectations, 2 = Sometimes Doesn't Meet Expectations, 1 = Seldom Meets Expectations, NA = Not Applicable Attendance and Punctuality

      1 2 3 4 5     N/A
  1. Arrives to work prepared and on time, with few absences   
  2. Proves to be responsible when taking emergency call   


Professionalism, Judgment, and Attitude

      1 2 3 4 5     N/A
  1. Exhibits self-direction and responsibility for actions   
  2. Demonstrates compassion for the patient and maintains his/her confidentality   
  3. Exhibits enthusiams and interest toward work   
  4. Establishes and maintains good rapport with co-workers   
  5. Recognizes the value of teamwork and functions wass as a member of the team   
  6. Exhibits a strong sense of ethical behavior and surgical conscience   
  7. Is receptive to constructive suggestions or corrections   
  8. Responds calmly and effectively under pressure   
  9. Observes rules of safety and takes no unnecessary risks   
  10. Adjusts well to new tasks and situations   
  11. Participates in continuing education and professional development   
  12. Demonstrates problem-solving skills   


Clinical Skills and Performance 1. Technical Knowledge Demonstrates a working knowledge of the following principles:

      1 2 3 4 5     N/A
  a. Surgical Anatomy and Physiology   
  b. Asepsis and Sterile Technique   
  c. Sterilization, Disinfection, and Antisepsis   
  d. Surgical Procedures and Specialties   
  e. Surgical Pharmacology and Anesthesia   
  f. Equipment, Supplies, and Instrumentation   
  g. Basic Case Preparation   
  h. Patient Care Concepts (e.g.: consent, identification, transportation, positioning, skin preparation, care of specimens, hemostasis)   


2. Technical Skills Demonstrates the desire and ability to perform the tasks necessary to prepare for the surgical procedure

      1 2 3 4 5     N/A
  a. Preoperative Skills and Routines   
  b. Intraoperative Skills and Routines   
  c. Postoperative Skills and Routines   


Part II Key: 5 = Strongly Agree, 4 = Agree, 3 = Somewhat Agree, 2 = Disagree, 1 = Strongly Disagree, NA = Not Applicable

      1 2 3 4 5     N/A
  1. In general, this graduate was adequately prepared for an entry-level position   
  2. Given the opportunity, I would hire another graduate from this program   
  3. The graduate needs little time after hiring to be supervised and monitored   


Part III Identify the graduate's strengths


Identify the graduate's weaknesses


What suggestions for improvement in training of future graduates would you like to make?


Comments concerning this graduate


Name and Title of Evaluator


Date





School of Health General
WI