Caregiver 90-Day Probation Review Form – Home Care Employee Performance Evaluation & HR Template | PDF and Word

Create a consistent and professional caregiver evaluation process with this Caregiver 90-Day Probation Review Form for Home Care Agencies.
Designed for non-medical home care agencies, personal care providers, private duty agencies, senior care businesses, HR managers, and care coordinators, this structured performance evaluation template helps supervisors document a caregiver’s performance during the initial probationary period.

The form records essential employment information including the caregiver’s name, position, hire date, review date, and supervisor.

WHAT’S INCLUDED
This Caregiver 90-Day Probation Review Form includes:
• Caregiver Name
• Position
• Hire Date
• Review Date
• Supervisor Name
• Job Performance Evaluation
• Attendance & Reliability Evaluation
• Care Skills & Competency Evaluation
• Communication Evaluation
• Policy & HIPAA Compliance Evaluation
• Supervisor Comment Areas
• Overall Strengths
• Areas for Improvement
• Employment Status Recommendation
• Caregiver Comments
• Caregiver Signature & Date
• Supervisor Signature & Date

CAREGIVER PERFORMANCE EVALUATION
Evaluate key areas of caregiver performance using a simple, consistent rating system.
The form includes four rating options:

✓ Excellent
✓ Good
✓ Satisfactory
✓ Needs Improvement

Each evaluation category also provides space for supervisor comments.

JOB PERFORMANCE
Document the caregiver’s overall job performance during the probationary period.
Use this section as part of your agency’s process for evaluating how effectively the employee is meeting assigned responsibilities and workplace expectations.

ATTENDANCE & RELIABILITY
Consistent attendance is especially important in home care, where clients depend on caregivers arriving for scheduled services.
The dedicated Attendance & Reliability section allows supervisors to assign a performance rating and provide supporting comments.

CARE SKILLS & COMPETENCY
Evaluate the caregiver’s performance in the Care Skills & Competency category and document relevant observations in the accompanying comments section.
This section can be incorporated into your agency’s broader competency, training, and supervisory review processes.

COMMUNICATION
Evaluate the caregiver’s communication performance and document supervisor feedback.
This section can help agencies maintain a consistent process for discussing communication expectations with caregivers during their initial employment period.

POLICY & HIPAA COMPLIANCE
The form includes a dedicated Policy & HIPAA Compliance evaluation category with the same Excellent-to-Needs-Improvement rating scale and an area for comments.
Use this section to document the supervisor’s assessment based on the agency’s applicable policies, training, privacy procedures, and employee expectations.

STRENGTHS & AREAS FOR IMPROVEMENT
Go beyond individual ratings with an Overall Assessment section.
Supervisors can document:

• Employee Strengths
• Areas for Improvement

This provides space for more detailed feedback and can help establish clear expectations moving forward.

EMPLOYMENT STATUS RECOMMENDATION
After completing the 90-day evaluation, document the supervisor’s recommended next step.
The form provides options for:

✓ Successfully Completed Probation
✓ Extend Probation Period
✓ Place on Performance Improvement Plan (PIP)
✓ Termination Recommended

If probation is extended, there is also a dedicated field for documenting the length of the extension.

CAREGIVER COMMENTS & SIGNATURES
Give the caregiver an opportunity to provide additional feedback with an optional Caregiver Comments section.
The form concludes with signature and date lines for both the:

• Caregiver
• Supervisor

PERFECT FOR
• Home Care Agencies
• Non-Medical Home Care Businesses
• Personal Care Agencies
• Private Duty Home Care
• Companion Care Agencies
• Senior Care Businesses
• Home Care Agency Owners
• HR Managers
• Home Care Administrators
• Care Coordinators
• Supervisors
• Caregiver Performance Reviews
• New Hire Evaluations
• Employee Probation Reviews
• Home Care HR Documentation
BUILD A STRUCTURED CAREGIVER REVIEW PROCESS
Use this form to help your agency:
✓ Standardize 90-day caregiver evaluations
✓ Document employee performance
✓ Review attendance and reliability
✓ Evaluate care skills and competency
✓ Document communication performance
✓ Review policy and privacy expectations
✓ Identify employee strengths
✓ Document areas needing improvement
✓ Record employment recommendations
✓ Maintain organized personnel records

CUSTOMIZABLE FOR YOUR HOME CARE AGENCY
Personalize the template with your:
• Agency Name
• Caregiver Information
• Employment Information
• Supervisor Information
• Performance Ratings
• Supervisor Comments
• Improvement Recommendations
• Employment Status Decision

DIGITAL DOWNLOAD
This is a digital product. No physical item will be shipped.
Your purchase includes a customizable 2-page Caregiver 90-Day Probation Review Form that can be incorporated into your agency’s employee onboarding, probationary review, and HR documentation processes.

Download the template, customize it for your home care agency, and use it when conducting caregiver probationary performance reviews.

IMPORTANT DISCLAIMER
This template is provided for general informational, administrative, and HR documentation purposes only. It does not constitute legal, employment, HIPAA, licensing, healthcare, or regulatory advice.
Use of this form does not by itself establish HIPAA, employment-law, licensing, audit, or regulatory compliance. Employment requirements involving probationary periods, performance evaluations, disciplinary action, termination, personnel records, employee privacy, and caregiver competency may vary by state, agency type, and circumstances.

Agencies should establish objective and consistently applied performance standards and customize the form to reflect their actual policies and applicable employment requirements.

Due to the nature of digital products, all sales are final.