FNS Peer Input Tool for Annual Evaluation: Systems Thinking Safety
Peer feedback for (RN name):
Directions:
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Evaluatee to send domain portions to peers who evaluatee would like feedback from
Clinical Thinking and Judgment domain is to be completed by another RN
Peers should indicate within the last column the level they feel is appropriate for the Evaluatee on each row
Peers are encouraged to support their views with concrete examples
Peers should complete the peer review within 7 Days and return electronically to the Manager/Designee and Evaluatee
Role Entry / Competent
Expert
Mastery
Peer Should Designate
Appropriate Level Below
DOMAIN: Systems Thinking Safety:
Develops an understanding of
aviation safety in the nontraditional patient care
environment
Articulates and implements
safety culture initiatives
Maintains an awareness of safety
issues for transport
Provides a safe and structured
environment for the
interdisciplinary team
Embraces a culture that is built
on a foundation of safe
practices in an aviation arena
and educates to those values
Evaluates vehicle components,
systems, and weather to meet
the needs of the transport
Develops contingency plans to
initiate/complete a transport
Articulates all FAA requirements
specific to operational control
Engages all members of the
interdisciplinary team to
promote a culture of safety
Please describe a time when you saw me at my very best. What qualities did I display in this domain?
Please provide your input regarding opportunities for my personal and/or professional growth
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I have completed the Peer Feedback Class as required by the UMPNC contract, paragraph 28E, for participation in the
peer review process.
Name:
Date:
Revised 7/2015 Professional Development Framework RSAM Steering Committee/JIT Approved.
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