Feedback Form School Nurses – Teacher: Observer: Grade level: Subject: Date: Domain 2: Health Services Environment Components Unsatisfactory Basic Proficient Distinguished 2a environment lack of attention to respectful provides privacy and respect in provides atmosphere of respect, Knowledgeable regarding laws of respect communication with students, all interactions with students, privacy and confidentiality in all and issues to family and school community family and school community interactions with students, family confidentiality. Consistently and school community provides information and resources to staff concerning such issues 2b management of components of school aware of knowledge of knowledge of components of school Knowledgeable of current trends, of school health services but components of school health health services; updates policies consistently implements trends health services priority services; implements programs and procedures as needed and prioritizes 2c organization lack of attention to safety respectful environment when continually assessing and adapting consistently advocates for of physical issues interacting with students, family space with respect to privacy and changes as necessary space and school community; confidentiality needs of students, attention to safety family and school community; 2d management lack of inventory; inconsistent efficient management of professional supervision of staff consistently evaluates and of health office when training staff; materials and supplies; efficient working in health office; maintains updates policies and procedures procedures documentation not completed delegation and staff training; accurate records so that data is related to management of in timely manner attention to documentation; easily retrievable health procedures records, reports done in timely manner
Feedback Form – School Nurses Teacher: Observer: Grade level: Subject: Date: Domain 2: Health Services Environment Components Unsatisfactory Basic Proficient Distinguished 2a environment of respect lack of attention to respectful communication with students, family and school community provides privacy and respect in all interactions with students, family and school community provides atmosphere of respect, privacy and confidentiality in all interactions with students, family and school community Knowledgeable regarding laws and issues to confidentiality. Consistently provides information and resources to staff concerning such issues 2b management of school health services of components of school health services but priority aware of knowledge of components of school health services; implements programs knowledge of components of school health services; updates policies and procedures as needed Knowledgeable of current trends, consistently implements trends and prioritizes 2c organization of physical space lack of attention to safety issues respectful environment when interacting with students, family and school community; attention to safety continually assessing and adapting space with respect to privacy and confidentiality needs of students, family and school community; consistently advocates for changes as necessary 2d management of health office procedures lack of inventory; inconsistent when training staff; documentation not completed in timely manner efficient management of materials and supplies; efficient delegation and staff training; attention to documentation; records, reports done in timely manner professional supervision of staff working in health office; maintains accurate records so that data is easily retrievable consistently evaluates and updates policies and procedures related to management of health procedures