School Nurseevaluation Form Academic Year

School NurseEvaluation Form
Academic Year:

......

Evaluee:

Evaluator:

Date of Evaluation:

......

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 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%)

......

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%)

1. Develops and implements appropriate health care plans

1. Train/delegate/supervise staff for nursing tasks

1. Provides for student health acute care needs, including emergencies

1. Oversees the medication administration policy

II)Meet Mandates for Student Health and Assessments (20%)

1. Directs the immunization program and monitors compliance

1. Conducts health assessments, including all required evaluations for students with suspected disabilities

1. Oversees vision and hearing screening programs

1. Manages communicable disease outbreaks

1. Work with the administration in supporting students with attendance issues

III)School Health Liaison (20%)

1. Communicate effectively to resolve conflict with students, parents, and community groups related to school health and wellness

1. Communicate effectively with community health care providers to support student health

1. Promote a healthy school community

1. 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%)

1. Provide timely and clear communication

1. Demonstrate initiative in personal achievements and team support

1. Adhere to the AA Employee Code of Conduct

......

Together, we have reviewed this performance evaluation and addressed all questions and comments.

School Nurse SignatureDate

Office Manager SignatureDate

......

I have reviewed this performance evaluation and addressed all questions and comments.

Executive Director of Schools SignatureDate

April 1, 2016Evaluation Form | Page 1