Supervisor Evaluation Form

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SUPERVISOR EVALUATION FORM
Supervisor’s Name: ___________________
Completed :
January
June
Instructions: to insure the quality of supervision provided to you as an SLPA please respond to the following items.
INITIAL ITEMS
RESPONSE
( check the appropriate response)
My Supervisor:
1. provided me a copy of the WVDE Guidelines for Use of Assistants in WV Public Schools.
Yes
No
2. explained my duties as an SPLA.
Yes
No
Please rate each subsequent item according the rating scale that follows.
1 = Yes; 2 = No; 3 = Sometimes; NA = Not Applicable
ONGOING ITEMS
RATING
(circle the appropriate response)
My supervisor:
Yes
No Sometimes
1. explained to me the type of documentation that is necessary to use for each therapy session.
1
2
3
NA
2. provided me with frequent, constructive verbal and/or feedback
Yes
No Sometimes
1
2
3
NA
about my performance
3. used a variety of ways of providing feedback to me about my performance e.g. verbal, written,
Yes
No Sometimes
1
2
3
NA
rating scale, videotape of the session, suggested self-evaluation, etc.
4. followed the suggestions in the WVDE Guidelines for Use of Assistants in WV Public Schools
Yes
No Sometimes
regarding supervision (i.e. minimum of 30% weekly; 20% direct supervision during the first 90 days
1
2
3
NA
of employment and minimum of 10% after the 90 day period) .
5. followed the suggestions in the WVDE Guidelines for Use of Assistants in WV Public Schools
Yes
No Sometimes
regarding indirect supervision (i.e. maximum of 10% indirect supervision during the first 90 days of
1
2
3
NA
employment and a maximum of 10% after the 90 day period).
Yes
No Sometimes
6. supervised me more frequently & gave me specific suggestions if I requested it or needed it.
1
2
3
NA
Cartwright, L. & Prichard, C., 2005
SUPERVISOR EVALUATION FORM
Supervisor’s Name: ___________________
Completed :
January
June
Instructions: to insure the quality of supervision provided to you as an SLPA please respond to the following items.
INITIAL ITEMS
RESPONSE
( check the appropriate response)
My Supervisor:
1. provided me a copy of the WVDE Guidelines for Use of Assistants in WV Public Schools.
Yes
No
2. explained my duties as an SPLA.
Yes
No
Please rate each subsequent item according the rating scale that follows.
1 = Yes; 2 = No; 3 = Sometimes; NA = Not Applicable
ONGOING ITEMS
RATING
(circle the appropriate response)
My supervisor:
Yes
No Sometimes
1. explained to me the type of documentation that is necessary to use for each therapy session.
1
2
3
NA
2. provided me with frequent, constructive verbal and/or feedback
Yes
No Sometimes
1
2
3
NA
about my performance
3. used a variety of ways of providing feedback to me about my performance e.g. verbal, written,
Yes
No Sometimes
1
2
3
NA
rating scale, videotape of the session, suggested self-evaluation, etc.
4. followed the suggestions in the WVDE Guidelines for Use of Assistants in WV Public Schools
Yes
No Sometimes
regarding supervision (i.e. minimum of 30% weekly; 20% direct supervision during the first 90 days
1
2
3
NA
of employment and minimum of 10% after the 90 day period) .
5. followed the suggestions in the WVDE Guidelines for Use of Assistants in WV Public Schools
Yes
No Sometimes
regarding indirect supervision (i.e. maximum of 10% indirect supervision during the first 90 days of
1
2
3
NA
employment and a maximum of 10% after the 90 day period).
Yes
No Sometimes
6. supervised me more frequently & gave me specific suggestions if I requested it or needed it.
1
2
3
NA
Cartwright, L. & Prichard, C., 2005
7. was always accessible in person, telephone, or pager during the time I worked with clients.
Yes
No Sometimes
1
2
3
NA
Yes
No Sometimes
1
2
3
NA
8. showed appropriate courtesy & respect for me.
Yes
No Sometimes
1
2
3
NA
9. answered questions about clinical matters satisfactorily.
10. was knowledgeable about clients, their communication disorders, and the therapy process in
Yes
No Sometimes
1
2
3
NA
general.
Yes
No Sometimes
1
2
3
NA
11. communicated effectively with me.
Yes
No Sometimes
1
2
3
NA
12. explained clinical procedures effectively.
Yes
No Sometimes
1
2
3
NA
13 encouraged me to participate in continuing education activities.
Yes
No Sometimes
1
2
3
NA
14. showed effective supervisory skills.
Comments:
(Please include meaningful comments regarding strengths and suggestions for improvement in the space below.)
Mail form to Kathryn Knighton, Program Coordinator upon completion in January and June.
Cartwright, L. & Prichard, C., 2005

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