ࡱ> U@ bjbj 8nJPPP8Q QD5h^R^R:RRRRRRO^Q^Q^Q^=^"cg$hR=kgTRRTTgRRgUUUTRRRO^UTO^UUVVRRR %U PTjVVdh05hVk]URkVVkVRLR6US,FS[RRRggd'F)'UF)sacramento city unified school district EVALUATION: CHILDRENS CENTER 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.Participates in the children's centers' enrollment conferences with parents and supervisors. Obtains developmental health history of children being enrolled, appraises child's health, makes necessary notations of health history and makes necessary referrals to proper agencies for follow-through and/or treatment. 2.Observes district nursing services policies and procedures including additional responsibilities which may be mandated by the State. 3.Plans with children's centers' director and supervisors regarding the children's centers' health services program. 4.Plans for supervisor, teacher and nurse conferences regarding health needs for individual children; confers with supervisors and teachers regarding ill or injured children. 5.Maintains health records of children. Consults with the supervisors as to when periodic physical examinations and booster shots are needed. 6.Assists in the provision of a safe and healthful center environment. 7.Fulfills health counseling role relative to health problems and follow-up of defects. Serves as a liaison with community resources. 8.Screens vision and hearing of all preschool children annually and school-age children at least every third year thereafter, or at more frequent intervals when indicated. 9.Is a resource person to instructional staffs and participates in staff development, including in-service leading to a first aid certificate; guides and assists teachers in daily screening and preparing children for such procedures as height, weight, physical examination, immunization and vision screening. 10.Works as a team member with Parent Advisory Council and with children's center personnel. 11.Reviews emergency procedures with children's center supervisors, recommends needed health supplies and health forms. 12.Responds in person to any major emergency call from a center (or school). 13.Participates in the management of suspected cases of child abuse and neglect. 14.Provides direct and indirect health and safety instructions to students, parents and staff. 15.Submits annual Children's Centers Health Report. Other Responsibilities Applicable to This Evaluation: 16. 17. 18. 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 01/19/05, Rev. 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