KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI

UNIVERSITAS SRIWIJAYA FAKULTAS KEDOKTERAN

PROGRAM STUDI KESEHATAN MATA
Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 580061
atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 352342,
Fax. 0711 373438

EVALUASI KINERJA 360o

Kuisioner ini akan bertujuan untuk mengetahui dan mengevaluasi performa dan kinerja individu lulusan FK
UNSRI program studi Kesehatan Mata yang namanya tercantum dibawah ini. Sebagai pihak yang sering
bekerja sama sehari-hari, masukan dan daran anda akan sangat bermanfaat untuk proses evaluasi
kinerja. Anda diperbolehkan untuk tidak mengisi nama anda.

Employee Name: ________________________________________________

Relation to Employee: ________________________________________________

Your Name (Optional): ________________________________________________

A few A few Every

Every times a times a few NA
Time Spent Day week month months (Never)
Your interaction with
employee

Strongly Strongl Not

Agree Agree Disagre y Applica
e Disagre ble
Quality of Work e
Sets high standards for
quality of work output
Ensures work is error-free
before submitting
Helps others improve the
quality of their work

Strongl
y Not
Strongly Disagre Disagre Applica
Communication Agree Agree e e ble
Communicates well orally
and in written-form
Displays good listening
skills
Shares information freely
with others

1
 KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI
UNIVERSITAS SRIWIJAYA FAKULTAS KEDOKTERAN
PROGRAM STUDI KESEHATAN MATA
Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 580061
atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 352342,
Fax. 0711 373438

Strongly Strongl Not

Teamwork Agree Agree Disagre y Applica
e Disagre ble
e
Contributes positively to
team
Helps define team roles
to maximize output
Can be counted on to
complete tasks correctly

Strongly Strongl Not

Personal Agree Agree Disagre y Applica
Qualifications and e Disagre ble
Leadership e
Presents a positive image
to outsiders
Is friendly and easy to
work with
Adapts well to change
Has high professional and
ethical standards

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