ࡱ> U@ bjbj ;mJ"*Z*Z*Z8bZ nZ"zs[[:8\8\8\8\8\8\iiii=ignr$ftRvxsF^8\8\F^F^s8\8\4s___F^p8\8\i_F^i_b_aa8\[ x *Z^|aaJs0zsa0w2_^0wa""0wa8\L\6_\,\`8\8\8\ss""d*/*_""/sacramento city unified school district EVALUATION: SCHOOL NURSE Name: School or Office: Position:  Rating Scale:Check One:1 Outstanding2 CommendableTemporary3 Satisfactory1st Year Probationary4 Needs to Improve2nd Year Probationary5 Unacceptable3rd Year ProbationaryNA Not ApplicablePermanent 1.In conformance with the district's philosophy, goals and objectives, health services are to promote the educability of youth by providing a consultive and health appraisal service to children, parents, and school personnel. To accomplish these goals and objectives, the school nurse: 2.Works within the capabilities of the pupils in the schools assigned in accomplishing health objectives. 3.Develops goals and objectives in the area of health and health education which are consistent with established district goals and objectives. 4.Works cooperatively with principals and other district administrators and supervisors in planning and implementing the health programs of the schools. 5.Maintains a behavioral climate in her health room and school surroundings conducive to health and health education. 6.Conducts health appraisals to evaluate the health and developmental status of the pupil in order to make a nursing diagnosis and establish a priority for action. 7.Interprets to school personnel, parents, and students results of examinations and screening tests. 8.Communicates with and serves as a consultant for parents, school personnel and pupils in regard to the health needs of pupils, and continues this communication to determine if necessary follow-up is completed. 9.Assists persons responsible for the pupils' health to locate appropriate community resources. 10.Communicates with principals and teachers regarding health conditions which might require special consideration or arrangements for the student while in class. 11.Uses available resources as a means of direct and indirect health education. 12.Helps to prevent and control disease. 13.Participates in planning the implementation of proper emergency care and first aid for sudden illness or accident, and gives general assistance when available. 14.Plans and coordinates the work of paraprofessionals, parents, and volunteers as assigned. 15.Offers advisory assistance and/or leadership in planning, promoting, and evaluating the health education program and is available to teachers as a resource person in all phases of the health education program. 16.Keeps accurate records and makes available information appropriate for inclusion in the cumulative records of the pupils. Executes and prepares such forms, records, and reports as may be called for in the management of the school heath program at the school plant and district level. 17.Exercises supervision and care over furniture, books, supplies, and equipment entrusted to her care relating to the health program, and instructs pupils in the proper use and preservation of school properties. 18.Attends meetings called by order of the principal, program director, or other administrator authorized to call meetings. 19.Serves, as requested, on school and district-wide committees and project teams. 20.Attends and participates in required inservice training activities, and works with the program director in planning her/his own inservice program. 21.Participates in the coordination of the school health program with the total health program of the school and the community. 22.Assists in interpreting the programs and goals of the school district to the community. 23.Performs other health related duties as required. Other Responsibilities Applicable to This Evaluation: 24. 25. 26. Overall Evaluation (Use rating scale 1 - 5, as defined on page 1) Specific Recommendations Made to Employee for Improving Services (Required for any certificated employee who has been rated less than acceptable in the performance of any of the duties and responsibilities listed above.) Comments Regarding Outstanding Performance (Optional) Recommendation: I recommend this employee be: Continued in the service of the district.Released from the service of the district.Reassigned to:Check here if additional material is submitted as part of this evaluation report. (Signed)Principal or Administrator in ChargeDate Employee's Acknowledgment: I have read this report, but my signature does not necessarily signify agreement. I understand that any written statement I wish to make regarding this report will be attached to all copies of it. It is understood that I am accountable only to the extent that I have control over the factors which contribute to the reaching of these goals and objectives. Employees Signature Date Witness's Verification (to be used if employee is unwilling to sign). I certify that a copy of this report was presented to the employee named on the first page on (date). (Signed)___________________________________________________  PAGE 4 01/20/05, Rev. 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