Form No. 4058 Date: November 2014 Policy: 4612 Social Worker

SUPPORT STAFF PERFORMANCE REVIEW DATE _____________________

EMPLOYEE NAME ___________________________________________ POSITION _____________________

EVALUATOR ___________________________________________ LOCATION _____________________

RESPONSIBILITY Superior Performance

Above Expectation

At Expectation

Needs Improvement

Unsatisfactory Performance

Maintains own daily attendance Observes work hours Displays appropriate grooming and apparel Respects procedures, rules and regulations Demonstrates positive work ethics Shows respect for District equipment, materials, and supplies Accepts responsibility for duties as assigned Indicates awareness of Policy Manual & Handbook Contents Adheres to Safety and Emergency Procedures Comments:

INTERPERSONAL SKILLS Superior Performance

Above Expectation

At Expectation

Needs Improvement

Unsatisfactory Performance

Demonstrates ability to work harmoniously with others Responds to needs of students, parents, and personnel Deals tactfully with others Contributes positively to team accomplishments Conveys care and feelings for students Expresses proficiency in communication skills Comments:

JUDGMENT Superior Performance

Above Expectation

At Expectation

Needs Improvement

Unsatisfactory Performance

Analyzes problems in a proficient manner Illustrates ability to make effective decisions Prioritizes job tasks efficiently Seeks ways to conserve District resources Senses when an issue needs to have supervisor’s attention and direction, and when it is beyond the scope of this position

Comments: Original: Human Resources Copies: Evaluator and Employee

Form No. 4058 Date: November 2014 Policy: 4612 Social Worker

SUPPORT STAFF PERFORMANCE REVIEW continued page 2 of 4 SOCIAL WORKER EMPLOYEE NAME ___________________________________________ DATE _____________________ ATTITUDE Superior

Performance Above

Expectation At

Expectation Needs

Improvement Unsatisfactory Performance

Demonstrates versatility by adjusting to changes Accepts direction, supervision and constructive criticism Works effectively under stress Demonstrates, by example, a positive image of district Comments:

PRODUCTIVITY Superior Performance

Above Expectation

At Expectation

Needs Improvement

Unsatisfactory Performance

Produces a high volume of quality work Meets deadlines in a timely manner Handles multiple responsibilities Utilizes time efficiently Comments:

INITIATIVE Superior Performance

Above Expectation

At Expectation

Needs Improvement

Unsatisfactory Performance

Receptive to new technology Solves appropriate problems/issues independently Accepts additional responsibilities willingly Portrays self reliance and requires little supervision Suggests improved methods for accomplishing tasks Demonstrates interest in learning and improving by attending District workshops and meetings

Comments:

*Support Staff Evaluation continues with completion of the appropriate page(s):

Form No. 4058 Date: November 2014 Policy: 4612 Social Worker

SUPPORT STAFF PERFORMANCE REVIEW continued page 3 of 4 SOCIAL WORKER EMPLOYEE NAME ___________________________________________ DATE _____________________ PROGRAM MANAGEMENT Superior

Performance Above

Expectation At

Expectation Needs

Improvement Unsatisfactory Performance N/A

Establishes and utilizes mechanism to address students at-risk for physical and/or psychological problems which interfere with or impede the learning process.

Communicates needs of students to appropriate school personnel and informs personnel about adaptations and interventions utilized to meet the needs of the students.

Establishes and utilizes a follow-up mechanism for referral of identified students.

Maintains documentation and files, and completes written reports to provide continuity and accountability of the program.

Consults with school administration to establish, review, and revise procedures for social services which are in compliance with state and local statutes.

Comments:

SOCIAL SERVICE PROCESS Superior Performance

Above Expectation

At Expectation

Needs Improvement

Unsatisfactory Performance N/A

Coordinates or provides services to students and/or families identified at-risk.

Works effectively with students and/or families, public and private agencies, and community groups to meet the identified needs of the student.

Refers student/family requiring long term intervention to proper resources, (ie; social agencies, physician, psychiatrist, psychologist, social worker, and other professionals).

Demonstrates application of theory by use of most recent techniques and information which governs actions.

Identifies the relationship between physical/mental/emotional health status and student’s ability to learn.

Provides crisis intervention which is primarily geared toward the protection of safety and emotional well-being of children.

Assists in facilitating the success of the Voluntary Transfer Student Program.

Comments:

Form No. 4058 Date: November 2014 Policy: 4612 Social Worker

SUPPORT STAFF PERFORMANCE REVIEW continued page 4 of 4 SOCIAL WORKER EMPLOYEE NAME ___________________________________________ DATE _____________________ INTERDISCIPLINARY COLLABORATION Superior

Performance Above

Expectation At

Expectation Needs

Improvement Unsatisfactory Performance N/A

Collaborates with other professionals in assessing, planning, implementing, and evaluating programs and activities to benefit students.

Contributes special knowledge of human behavior and relationships to staff by assisting with staff development in the area of social problems; and by serving on school/district wide committees.

Comments:

PROFESSIONAL DEVELOPMENT Superior Performance

Above Expectation

At Expectation

Needs Improvement

Unsatisfactory Performance N/A

Contributes to the professional growth of others by providing inservice when needed.

Participates in continuing education programs to increase knowledge base and understanding and update skills (evidence provided).

Comments: COMMENTS BY EVALUATOR: COMMENTS BY EMPLOYEE: ________________________________ ____________ ________________________________ ____________ EMPLOYEE’S SIGNATURE DATE EVALUATOR’S SIGNATURE DATE