SIOUXLAND COMMUNITY HEALTH CENTER SIOUX CITY, IOWA PERFORMANCE EVALUATION-COMPETENCY

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SIOUXLAND COMMUNITY HEALTH CENTER SIOUX CITY, IOWA PERFORMANCE EVALUATION-COMPETENCY Employee Position: Pharmacy Technician Department: Pharmacy Date Rating for: 90 day Probation Extended Probation Annual Special Review Rating: +2 = Exemplary Performance +1 = Exceeds Criteria 0 = Meets Criteria -1 = Partially Met Criteria -2 = Unsatisfactory Score of -2 requires comments written in Comments/Action Plan. A. Demonstrates ability to perform the general functions of the position. a. Provides quality pharmaceutical care within SCHC. b. Assists and supports clinical, administrative and pharmacy staff on pharmaceutical matters. c. Waits on and gathers required demographic information from patients at prescription drop-off window. d. Fills prescriptions under the supervision of a registered pharmacist. e. Takes incoming calls for patient prescription refills. f. Orders pharmaceuticals from vendors and maintains inventory of pharmaceutical supplies. g. Files and submits all pharmacy insurance claims to the Claims Processor and corrects any rejected claims. h. Performs special pharmacy bills. i. Cleans and maintains pharmaceutical equipment and pharmacy work areas. j. Balances cash register daily. k. Makes entries in Daily Prescription Log. l. Able to run medical use reports from computer.

Performance Evaluation Page 2 B. & C. Accountable for maintaining and updating specific knowledge and competence. D. Responsible to demonstrate dependability as an employee through flexibility, punctuality and attendance. E. Responsible to demonstrate initiative and judgment m. Knows how to access medicines and fill out appropriate paperwork. n. Documents sample medication use. o. Checks medicines for expiration dates. 1. Obtains CEU s to maintain current pharmacy technician certification (if appropriate). 2. Assures CEU certificates are given to Personnel Department. 1. Observes work hours and time clock regulations. 2. Consistently punctual in reporting to work and to and from work breaks. 3. Maintains a good attendance record, keeping absenteeism at a minimum. 4. Demonstrates flexibility in staffing and work practices and supports cross training as patient/customer needs require. 5. Regularly attends department meetings. 6. Participates in mandatory inservices as stipulated by the department and/or SCHC. 1. Demonstrates self-motivation and the ability to work independently. 2. Demonstrates the ability to comply with established policies and procedures. 3. Demonstrates good time management in the completion of job functions. 4. Demonstrates sound judgment and composure in response to emotional or emergent situations. 5. Demonstrates good judgment through

Performance Evaluation Page 3 F. Demonstrates the ability to work with coworkers, patients, visitors and other members of the healthcare team. G. Complies with SCHC ethical standards H. Responsible to obtain and maintain knowledge of measures to ensure self, patient, family and coworker safety. characteristics of appropriate personal appearance and personal hygiene. 6. Assists supervisor with development and updating of policies and procedures. 1. Able to communicate effectively with all ages served (newborn, pediatric, adolescent, adult and geriatric) as applicable. 2. Demonstrates the ability to work in a team environment, reaffirming the contribution of each person to the delivery of care/services. 3. Promotes/maintains positive inter and intra department relations. 4. Participates in department/schc committees as applicable 1. Complies with SCHC ethical standards. 2. Demonstrates stewardship in the performance of daily business operations through accuracy of work and compliance with regulations. 3. Demonstrates knowledge of the SCHC personnel manual. 4. Demonstrates knowledge of SCHC policies, procedures and manuals pertinent to department. 1. Demonstrates knowledge of safety/security measures in the Environment of Care (responses to tornado, fire, violence, bomb threats). 2. Practices safe work habits. Ergonomics (back safety, repetitive

Performance Evaluation Page 4 I. Contributes to the mission, vision and values of the SCHC. action) Environmental Safety Surveillance Hazardous Materials Utility Management Infection Control Practices (Standard Precautions) 3. Demonstrates ability to employ effective coping mechanisms to deal with emotional situations. 1. Demonstrates respect for the dignity and integrity of each person with courtesy and compassion while respecting cultural differences. 2. Demonstrates efficient, high-quality and cost effective services in a thorough, efficient, caring and knowledgeable manner providing family-centered holistic care. 3. Demonstrates quality care that is missiondriven, accessible, patient-oriented and fulfills our responsibility to meet the health care needs of the Siouxland community. 4. Manages information in a professional, private and confidential manner. Note: Enter average of each section below, then average A through I for total score. A B-C D E F G H I Total Score = 0 + 1 + 2 = Meets Expectations -1-2 = Does not meet expectations Supervisor

Performance Evaluation Page 5 Goals or Recommendations: Employee Comment or Self-Goals: Retain on Probation: YES NO N/A Evaluation Completed: YES NO Date: Employee Signature Date Next evaluation Date: Department Manager Signature Date