YOUNG HOUSE FAMILY SERVICES
EMPLOYEE EVALUATION
FAMILY SUPPORT CASEWORKER
Community Based Services (BHIS, BIS, Aftercare)
EMPLOYEE NAME DATE OF EVALUATION
PROGRAM ______DATE OF HIRE
SUPERVISOR
Score the performance in each area below on a scale of 4 to 1, as follows:
4 = Outstanding; consistently exceeds this job expectation.
3 = Meets expectations; consistently meets this job expectation.
2 = Below expectations; occasionally fails to meet this job expectation.
1 = Immediate need for improvement; consistently fails to meet this job expectation.
N/A = Not applicable
SECTION 1 – JOB PERFORMANCE
Essential Job Duties (from Family Support Caseworker Job Description) Score
▪ Carries a client caseload as required, which includes preparing for and
conducting individual and family sessions. _____
▪ Performs caseworker duties, including liaison work, collaboration with families,
clinicians, support services, documentation, case management, educational
tracking, etc. _____
▪ Demonstrates effective skills in engaging children & families . _____
▪ Is in compliance with agency expectations for fulfilling required utilization
requirements. _____
▪ Completes all paperwork responsibilities (assessments, contact notes, quarterly,
discharge, & end of year reports, etc.) accurately and timely, and in accordance
with contractual requirements & agency standards. _____
▪ Demonstrates professional writing and grammar skills in completion of paperwork. _____
▪ Completes file maintenance duties as assigned, ensuring files contain all
required documentation. Q _____
▪ Enters required information into the agency’s computer database system
accurately & timely. _____
▪ Oversees the implementation & coordination of delivery of treatment plans for
BHIS. Completes service plans for other community based programs, as
required by contracts. _____
▪ Establishes and maintains collateral contacts with family, referral worker,
community resources, and support system of client and family. _____
▪ Adheres to agency guidelines & expectations regarding clinical supervision. _____
▪ Establishes and maintains professional boundaries with clients, families, &
coworkers. _____
▪ Transports clients as assigned, driving agency vehicles or personal vehicle
if necessary. (Must meet agency guidelines to be an approved driver.) _____
Section 1 Total Score (52 points possible) _____
EMPLOYEE NAME DATE OF EVALUATION
SECTION 2 – PERSONAL PERFORMANCE
Score
▪ Attendance & Punctuality _____
▪ Interpersonal Skills (Gets along well with others) _____
▪ Responds to Supervision (Follows through on directives) _____
▪ Communication Skills (Effective, professional, respectful, etc.) _____
▪ Teamwork (Works cooperatively to promote an effective team environment) _____
▪ Contributes to Agency Culture (Makes a positive contribution by supporting
the overall mission, philosophy & agency values) _____
▪ Completes required agency training promptly as assigned _____
▪ Adheres to agency policies & procedures _____
Section 2 Total Score (32 points possible) _____
TOTAL SCORE (add Section 1 and Section 2) (84 points possible): _____
Total % Score: _____
EVALUATION SUMMARY, RECOMMENDATIONS AND GOALS
EMPLOYEE NAME DATE OF EVALUATION
Supervisor Summary
AREAS OF STRENGTH:
AREAS NEEDING IMPROVEMENT: (Including additional training needs):
ADDITIONAL COMMENTS:
Employee Comments and Response to Evaluation:
GOALS OF PREVIOUS EVALUATION: (List) Achieved Not Achieved
If not achieved, state reasons and describe plan:
PRESENT GOALS AND/OR TRAINING NEEDS:
EVALUATION SIGNATURE PAGE
EMPLOYEE NAME DATE OF EVALUATION
This performance evaluation has been discussed with me, and I understand that my signature does not necessarily indicate agreement.
Employee’s Signature: Printed Name: _____ Date:
Program Director’s Signature:
Program Director’s Printed Name: _____ Date:
Executive Director’s Signature:
Executive Director’s Printed Name: Date:
\sue\2017-18 evaluations\CBS Caseworker evaluation form 2017
Employee Evaluation
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