Fillable Graduate Registered Nurse and Midwife Referee Report (Queensland Health)

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Graduate Registered Nurse and Midwife Referee Report (Queensland Health)

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Graduate Registered Nurse and Midwife – Referee Report
You have been nominated as a referee for an applicant seeking a Graduate Registered Nurse or Midwife role with
Queensland Health. Please comment regarding the applicant’s ability and behaviour in relation to the following questions
including key skill requirements for the role in question. Queensland Health recognises and appreciates your assistance in
this process.
Please note:
• When a referee provides an adverse comment in a referee report, the panel has an obligation to disclose those
comments to the applicant.
• Referees covered by the Recruitment and Selection Directive 15/13 must disclose all information known to them
regarding the applicant’s ability to fulfil the role and workplace behaviours, even if not directly requested by the
panel. The omission of relevant information or untruthful information constitutes grounds for discipline.
Referee Report Details
Referee name:
Referee position title:
Applicant’s name:
Professional relationship
Do you have a personal relationship
with the applicant or a conflict of
interest in providing this reference?
Yes No
Comment:
For what period have you known the
applicant?
Please provide dates as
DD/MM/YYYY.
In what professional capacity is the
applicant known to you?
What position was held by the
applicant?
Job performance
During the time you have known the
applicant, how would you
characterise their performance in
general?
Excellent Good Adequate Poor Not Observed
Comment:
Computer skills
Excellent Good Adequate Poor Not Observed
Describe the applicant’s time
management and knowledge base in
relation to a graduate Registered
Nurse or Midwife role (including their
strengths and weaknesses).
If unable to comment on the nursing
or midwifery role, please state this in
your response and comment on the
applicant’s performance in their
current role.
Graduate Registered Nurse and Midwife
Referee Report
Graduate Registered Nurse and Midwife – Referee Report Page 2 of 3
Applicant Name:
Work ethic, reliability and punctuality
Punctuality and reliability
Excellent Good Adequate Poor Not Observed
Organisational skills
Excellent Good Adequate Poor Not Observed
Initiative
Excellent Good Adequate Poor Not Observed
Does the applicant contribute
positively to the workplace?
Yes No
Comment:
How does the applicant
respond to feedback and
development opportunities?
Additional comments on work
ethic, reliability and
punctuality.
Does the applicant take
accountability for their actions
and decisions?
Communication and interpersonal skills
Communication and rapport
with patients/clients
Excellent Good Adequate Poor Not Observed
Relationships are key to this
role. Comment on the
applicant’s ability to build and
maintain key relationships.
How would you describe their
approach? What is their
relationship with other health
professionals or members of
the work team?
Excellent Good Adequate Poor Not Observed
Comment:
Does the applicant
demonstrate respect in the
workplace with their colleagues
and clients? How is respect
reflected in their
communication with others?
Additional comments on
interpersonal skills.
Employability
Applicant’s attendance as an
employee or student.
Below average Average Above average
Are you aware of any medical
condition (mental or physical -
including substance abuse or
dependence) which may affect
the applicant’s ability to
perform this role competently
and safely?
Yes No
If yes, note the actions taken to address concerns.
Comment:
Has the applicant needed to be
counselled about excessive sick
leave or patterns of absence?
Yes No
Comment:
Graduate Registered Nurse and Midwife – Referee Report Page 3 of 3
Thank you for your time and valued response
Information for referees
1. Nursing and midwifery graduate applicants are responsible for bringing completed referee reports to their interview.
2. Referee reports must be returned directly to the nursing or midwifery graduate applicant.
3. Referee reports must be hand signed by the referee or include an electronic signature (not name written in italics or fancy
font).
4. Referees must meet one of the following criteria:
a. Nursing/Midwifery Clinical Facilitator from the applicant’s final year of study or Nurse Unit Manager/Preceptor who has
been directly responsible for the applicant’s clinical placement supervision for two (2) weeks or more full time (or a
minimum of 80 hours placement) and has direct knowledge of clinical performance;
or
b. Current Line Manager (or previous line Manager from within the last two (2) years, if not currently employed) who has a
direct supervisory role. This does not need to be a nursing/midwifery position;
or
c. Supervisor for a volunteer position e.g. St John’s Ambulance, Red Cross, sports coaching. The referee must be a direct
supervisor of the applicant.
5. Referee reports which are returned to the applicant via email must be forwarded from the referee’s work email account, not a
personal email account.
Emails must include the declaration outlined below:
I, <insert name> have completed this referee report and returned it via email to the nursing/midwifery graduate applicant
whose name appears on the top of this referee report. This report includes my signature and is a true and accurate reflection
of my knowledge of the applicant. The applicant is requested to bring the referee report and this email to their interview.
6. Emailed referee reports must be forwarded to the applicant in PDF format.
7. Referee reports are not to be forwarded directly to Queensland Health facilities.
8. Referee reports are valid for 12 months from date of signature.
9. Referees who do not wish referee reports to be viewed by the applicant prior to review by the interview panel, should
indicate by ticking the box below and placing the report in a sealed envelope. Please sign across the envelope seal to identify
envelope has been sealed by the referee. These reports must be returned directly to the applicant to bring to their interview.
Sealed referee report provided to applicant
Applicant Name:
Are you aware of any poor
performance issues, formal
complaints, disciplinary or
legal action against the
applicant?
If so, what were the issues
and what was the outcome?
Yes No
If yes, provide details.
Comment:
Would you offer the applicant
another position in your work
area or recommend them for
employment as a graduate
Registered Nurse/Midwife?
Why?
Yes No
If no, please explain why.
Comment:
Referee details (this information is mandatory)
Name:
Position:
AHPRA Registration Number
(if clinical referee):
Place of employment:
Signature
Date
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Graduate Registered Nurse and Midwife Referee Report (Queensland Health)

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Completed 5 September 2020

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