"Certified Reviewer Status Form" - Florida

Certified Reviewer Status Form is a legal document that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida.

Form Details:

  • Released on June 28, 2016;
  • The latest edition currently provided by the Florida Department of Juvenile Justice;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Bureau of Monitoring and Quality Improvement
Certified Reviewer Status Form
Certified Reviewer Information
(to be entered electronically by reviewer during each review)
Name of person completing form:
Date completed:
Name:
Title:
Education:
Licensing:
(MSW, RN, LMHC)
Number of years’ experience in Juvenile Justice programs:
Motivational Interviewing (MI) Completion Date:
Travel Ability:
Local
Overnight
Program Type:
Community Supervision
Prevention
Day Treatment
Detention
Diversion
PACE
Residential
Non-Program
Certified Reviewer’s Place of
Employment(Program Name):
Program
Address:
Information
City:
State:
Zip:
Circuit:
Phone:
Fax:
Certified Reviewer’s Email Address:
Supervisor Name and Title:
Supervisor’s Email Address:
Certified Reviewer’s Provider Agency:
This section to be completed by the Lead Reviewer
Weak (did very little; not a team player)
Overall Rating of Peer Performance:
Average (met reasonable expectations; a member of the team)
Excellent (effort went above and beyond the call of duty; a team player)
Rating Justification:
Standard and Indicator(s) Reviewed:
Standard 1
Standard 2
Standard 3
Standard 4
Standard 5
Program Reviewed:
Review Dates:
Lead Reviewer:
Region:
Certified Reviewer Status Form
Revised 6/28/16
Effective 7/1/16
Save As..
Print
Clear Form
Bureau of Monitoring and Quality Improvement
Certified Reviewer Status Form
Certified Reviewer Information
(to be entered electronically by reviewer during each review)
Name of person completing form:
Date completed:
Name:
Title:
Education:
Licensing:
(MSW, RN, LMHC)
Number of years’ experience in Juvenile Justice programs:
Motivational Interviewing (MI) Completion Date:
Travel Ability:
Local
Overnight
Program Type:
Community Supervision
Prevention
Day Treatment
Detention
Diversion
PACE
Residential
Non-Program
Certified Reviewer’s Place of
Employment(Program Name):
Program
Address:
Information
City:
State:
Zip:
Circuit:
Phone:
Fax:
Certified Reviewer’s Email Address:
Supervisor Name and Title:
Supervisor’s Email Address:
Certified Reviewer’s Provider Agency:
This section to be completed by the Lead Reviewer
Weak (did very little; not a team player)
Overall Rating of Peer Performance:
Average (met reasonable expectations; a member of the team)
Excellent (effort went above and beyond the call of duty; a team player)
Rating Justification:
Standard and Indicator(s) Reviewed:
Standard 1
Standard 2
Standard 3
Standard 4
Standard 5
Program Reviewed:
Review Dates:
Lead Reviewer:
Region:
Certified Reviewer Status Form
Revised 6/28/16
Effective 7/1/16
Save As..
Print
Clear Form