Appropriate follow-up questions are not Adequate follow-up questions are not always Adequate and appropriate follow-up questions asked asked are asked Questions are asked in a leading and/or Some available assessment data is not used Uses all available and relevant assessment data judgmental manner Irrelevant data is sometimes used Question are asked in a non-judgmental, Available and relevant assessment data is Leading or judgmental questions are asked on manner ignored or not noticed occasion Nutrition Assessment is not individualized; unnecessary or repetitive questions are asked Comments: Score: _____ Identifies and documents All applicable risks are not generally Inconsistently identifies all applicable risks Uses information collected to identify and nutrition risk factors assigned Non-applicable risks are assigned on individualize nutrition risks Non-applicable risks are assigned occasion. All applicable risks are assigned Documentation of the risk for risk Inconsistently documents the reason for risk Documents reason for risk assignment when assignment when applicable is not done assignment when applicable applicable Additional documented is not completed Additional information is not consistently Documents importation information gleaned from The Nutrition Risk Manual is not referred to documented assessment when needed The Nutrition Risk Manual is not always Refers to Nutrition Risk Manual when necessary referred to when necessary Comments: Score: _____ Uses information Information obtained is not used to tailor Information is used inconsistently to tailor Uses information obtained to tailor food obtained from nutrition food packages, provide nutrition education food packages, provide nutrition education packages, provide nutrition education and make assessment and make appropriate referrals and make appropriate referrals appropriate referrals Comments: Score: _____ Lacks Competence Needs Improvement Demonstrates Competence Referrals 0 1 2 Identifies and refers Documents the status of a referral without Inconsistently refers clients to appropriate Clients are referred to appropriate health and clients asking clients health and social programs social programs (mandatory and additional referrals)
Appropriate follow-up questions are not asked Questions are asked in a leading and/or judgmental manner Available and relevant assessment data is ignored or not noticed Nutrition Assessment is not individualized; unnecessary or repetitive questions are asked Adequate follow-up questions are not always asked Some available assessment data is not used Irrelevant data is sometimes used Leading or judgmental questions are asked on occasion Adequate and appropriate follow-up questions are asked Uses all available and relevant assessment data Question are asked in a non-judgmental, manner Score: _____ Comments: Identifies and documents nutrition risk factors All applicable risks are not generally assigned Non-applicable risks are assigned Documentation of the risk for risk assignment when applicable is not done Additional documented is not completed The Nutrition Risk Manual is not referred to when needed Inconsistently identifies all applicable risks Non-applicable risks are assigned on occasion. Inconsistently documents the reason for risk assignment when applicable Additional information is not consistently documented The Nutrition Risk Manual is not always referred to when necessary Uses information collected to identify and individualize nutrition risks All applicable risks are assigned Documents reason for risk assignment when applicable Documents importation information gleaned from assessment Refers to Nutrition Risk Manual when necessary Score: _____ Comments: Uses information obtained from nutrition assessment Information obtained is not used to tailor food packages, provide nutrition education and make appropriate referrals Information is used inconsistently to tailor food packages, provide nutrition education and make appropriate referrals Uses information obtained to tailor food packages, provide nutrition education and make appropriate referrals Score: _____ Comments: Referrals Lacks Competence 0 Needs Improvement 1 Demonstrates Competence 2 Identifies and refers clients Documents the status of a referral without asking clients Inconsistently refers clients to appropriate health and social programs Clients are referred to appropriate health and social programs (mandatory and additional referrals)
ITCA_2015Jan_Chp13.AttC_.WIC-Staff-Competency-Evaluation-Scoring-Sheet.fillable.docx