School NurseEvaluation Form
Academic Year:
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Evaluee:
Evaluator:
Date of Evaluation:
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Evaluation Summary
Objectives were previously identified and agreed upon per School NurseJob Responsibilities document in the following areas; please make specific comments/observations on each and assign a rating from 1 to 4.
RATING / WEIGHT X RATING / RATING / WEIGHT X RATINGCategory / Weight / Self-Evaluation / Weighted
Self-Evaluation Rating / Admin
Evaluation / Weighted Administrator Rating
I.Address Student Health Needs / 50%
II.Meet Mandates for Student Health and Assessments / 20%
III.School Health Liaison / 20%
IV.Positive Contribution to the
School Environment / 10%
100%
Rating Scale: 4 = Exceeds expectations; 3 = Proficient expectations; 2 = Developing expectations; 1 = Expectations not met
High-Level Responsibilities
I)Address Student Health Needs (50%)
II)Meet Mandates for Student Health and Assessments (20%)
III)School Health Liaison (20%)
IV)Positive Contribution to the School Environment (10%)
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Evaluation
Overall Comments
Include in your comment: "Congratulations! You will receive a raise of $XX (XX%) bringing your new contract amount to $XX,XXX."
I)Address Student Health Needs (50%)
- Develops and implements appropriate health care plans
- Train/delegate/supervise staff for nursing tasks
- Provides for student health acute care needs, including emergencies
- Oversees the medication administration policy
II)Meet Mandates for Student Health and Assessments (20%)
- Directs the immunization program and monitors compliance
- Conducts health assessments, including all required evaluations for students with suspected disabilities
- Oversees vision and hearing screening programs
- Manages communicable disease outbreaks
- Work with the administration in supporting students with attendance issues
III)School Health Liaison (20%)
- Communicate effectively to resolve conflict with students, parents, and community groups related to school health and wellness
- Communicate effectively with community health care providers to support student health
- Promote a healthy school community
- Coordinate with staff, parents, and outside groups for overnight field trips to ensure student health and safety
IV)Positive contribution to the school environment (10%)
- Provide timely and clear communication
- Demonstrate initiative in personal achievements and team support
- Adhere to the AA Employee Code of Conduct
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Together, we have reviewed this performance evaluation and addressed all questions and comments.
School Nurse SignatureDate
Office Manager SignatureDate
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I have reviewed this performance evaluation and addressed all questions and comments.
Executive Director of Schools SignatureDate
April 1, 2016Evaluation Form | Page 1