Feedback Form School Nurses – Teacher: Observer: Grade level: Subject: Date: DOMAIN 4: Professional Responsibilities Components Unsatisfactory Basic Proficient Distinguished 4a collaborates gives minimal input to school team player; interacts with students uses position to unique consistently anticipates need with others avoids interactions with and families; works with school perspective to school teams (504, for collaborative teaming students, family and school staff; shares information as EST); interacts effectively with community appropriate as advocate for other agencies as needed; makes students and families referrals as needed 4b communicates lack of communication and communicates information communicates with and engages consistently supports and with families follow up with families students as appropriate to families in follow up advocates for families parents 4c demonstrates occasional meetings with regular meetings with colleagues works with interdisciplinary team participates in professional collegiality and colleagues; demonstrates where sharing of information to accomplish goals; acts in organizations; consistently Professionalism minimal professional growth occurs; provides expected respectful and ethical manner on advocates for professional services to students; respectful behalf of students; proactive in school nursing at the district, of students; positive attitude promoting health careers community and state level shows in work ethic and health career
Feedback Form – School Nurses Teacher: Observer: Grade level: Subject: Date: DOMAIN 4: Professional Responsibilities Components Unsatisfactory Basic Proficient Distinguished 4a collaborates with others gives minimal input to school avoids interactions with students, family and school community team player; interacts with students and families; works with school staff; shares information as appropriate as advocate for students and families uses position to unique perspective to school teams (504, EST); interacts effectively with other agencies as needed; makes referrals as needed consistently anticipates need for collaborative teaming 4b communicates with families lack of communication and follow up with families communicates information students as appropriate to parents communicates with and engages families in follow up consistently supports and advocates for families 4c demonstrates collegiality and Professionalism occasional meetings with colleagues; demonstrates minimal professional growth regular meetings with colleagues where sharing of information occurs; provides expected services to students; respectful of students; positive attitude shows in work ethic and health career works with interdisciplinary team to accomplish goals; acts in respectful and ethical manner on behalf of students; proactive in promoting health careers participates in professional organizations; consistently advocates for professional school nursing at the district, community and state level