Board Member Self Assessment

Please complete this confidential questionnaire below and click the Submit button at the bottom to send. Anonymous results of the summary will be shared at a later board meeting. Thank you.

• Hospital
• Foundation
• Both Hospital & Foundation

• YES
• NO
• NEEDS WORK

2. I prepare for, regularly attend, and actively participate in Board meetings.

1. I understand my role and duties as a Board member, including appropriate planning for the programs and financial needs of the organization, maintaining medical staff credentialing, and having an appropriate patient care quality control process.

• YES
• NO
• NEEDS WORK

3. I am responsible for identifying and referring significant issues to the hospital CEO and the chairperson of the Board to assure that the organization is properly managed.

• YES
• NO
• NEEDS WORK

• YES
• NO
• NEEDS WORK

4. I am willing to volunteer for Board tasks and assignments.

5. I support the institution and CEO in the work of civic, business and community relationships.

• YES
• NO
• NEEDS WORK

6. I understand and am willing to declare a conflict of interest when appropriate.

• YES
• NO
• NEEDS WORK

7. I keep current regarding healthcare trends and legislation affecting the delivery of healthcare.

• YES
• NO
• NEEDS WORK

Comments to strengthen or enhance Board effectiveness: