Denver Public Schools
Denver Online Work Study/Service Learning Evaluation
Student Name: ______ / Worksite Name: ______Worksite Address: Phone: Supervisor Name: ______
Occupational Title: Avg. Hours Per Week: Rate of Pay: ______
Specific Job Skill Development: Please list skills that the student will acquire during the internship experience. / Excellent / Good / Average / Needs Improvement / Unacceptable
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Dates Covered By This Report: Terminated? YES NO
Attendance / Excellent / Good / Average / Needs Improvement / Unacceptable
1. Attends work regularly; works scheduled hours
2. Calls supervisor when tardy or absent
3. Begins work on time
Comments:
Work Habits / Excellent / Good / Average / Needs Improvement / Unacceptable
4. Uses work time appropriately and completed tasks in a timely manner
5. Performs job safely and accurately
6. Respects all privileges, including breaks
7. Shows initiative; assumes responsibility
8. Follows directions and retains information
Comments:
Skills and Knowledge / Excellent / Good / Average / Needs Improvement / Unacceptable
9. Solves problems on his or her own
10. Asks questions when needed
11. Uses appropriate verbal and non-verbal communication skills
12. Reports needs or issues that may affect job performance
13. Demonstrated behavior expected in the workplace.
Comments:
Attitudes and Attributes / Excellent / Good / Average / Needs Improvement / Unacceptable
14. Dresses appropriately with attention to grooming and hygiene
15. Demonstrates good teamwork
16. Is willing to learn and fully participate
17. Shows respect for supervisor and co-workers
18. Continues to show improvement
19.Resolves conflicts successfully
20. Is respectful of workplace diversity
21. Accepts feedback from supervisor and co-worker
Comments:
Supervisor Signature:______
Student Signature: ______
Counselor Signature: ______/ Date: ______
Date: ______
Date: ______
______
SCHOOL USE ONLY: Hours of Work ______
# of Work Study/Service Learning Credits ______
Areas of Strength as a Worker:
Areas Needing Improvement or Support:
Recommendations for Next Work Placement:
Other Comments: