Completed By
Date
Phone Number
Time
Language
Interpreter Name
Interpretation Site
Client Name
Was the interpreter on time? Yes No
If NO, were you notified? Yes No
Was the interpreter wearing a badge? Yes No
Was the interpreter dressed appropriately? Yes No
Was the interpreter fluent in both languages? Yes No
Was the interpreter informing completely both sides about the matter of the appointment? Yes No
Was the interpreter ensuring to understand the information to be translated? Yes No
Was the interpreter sharing cultural information that could be relevant & could help eliminate difficulty? Yes No
Was the interpreter remaining neutral during the appointment? Yes No
Please rate the interpreter's overall performance Excellent Good Average Poor
Client/Patient, please rate the interpreter's overall performance Excellent Good Average Poor
Additional Comments
