Page 1 of 2
Davie County Schools
Occupational Therapist Performance Appraisal Instrument
1. The evaluator is to rate the Occupational Therapist on a four-point scale listed below.
2. The competencies pertinent to each major function must be selected and discussed by the
supervisor and Occupational Therapist at the beginning of the year.
3. The evaluator is encouraged to add pertinent comments at the end of each major function.
4. The Occupational Therapist is provided an opportunity to react to the evaluator’s ratings and comments.
5. The evaluator and the Occupational Therapist must discuss the results of the appraisal and any
recommended action pertinent to it.
6. The Occupational Therapist and the evaluator must sign the instrument in the assigned spaces.
7. The instrument must be filed in the Occupational Therapist’s personnel folder.
Occupational Therapist’s Name:
School or Base Assignment:
1.0 Major Function: Assessment
1.1 Establishes and maintains a referral process.
1.2 Collects and views student information.
1.3 Conducts occupational therapy screening of students.
1.4 Documents and communicates screening results.
1.5 Selects appropriate evaluation instruments and procedures.
1.6 Administers formal and informal tests.
1.7 Interprets evaluation data.
1.8 Documents and communicates evaluation information.
1.9 Completes reassessment as needed.
2.0 Major Function: Program Planning
2.1 Coordinates occupational therapy services with school personnel and other community
2.2 Participates in conferences pertinent to student’s occupational therapy needs.
2.3 Participates in developing individual educational plans.
2.4 Designs intervention/service delivery program.
2.5 Maintains documentation of occupational therapy program plan.
3.0 Major Function: Intervention/Service Delivery
3.1 Provides direct intervention services.
3.2 Manages intervention programs carried out by others.
3.3 Discontinues intervention program when appropriate.
3.4 Provides child-specific consultation.
Page 2 of 2
4.0 Major Function: Consultation/Education
4.1 Promotes awareness of the roles and function of occupational therapy in the school
4.2 Provides formal/informal in-service education.
4.3 Facilitates the acceptance of students with special needs.
4.4 Assists in the formulation and/or modification of programs.
4.5 Serves as a resource on medically related issues.
4.6 Provides information on architectural barriers, classroom modifications, and/or safety
5.0 Major Function: Communication
5.1 Promotes effective interpersonal relations.
5.2 Communicates effectively in verbal and written expressions.
5.3 Promotes effective interdisciplinary relationships.
5.4 Provides liaison with outside agencies and services.
6.0 Major Function: Program Management
6.1 Implements policies and directives of the administration.
6.2 Establishes priorities and schedules for occupational therapy services with appropriate school personnel.
6.3 Manages time efficiently.
6.4 Maintains clinical and administrative records.
6.5 Assists in budget planning for occupational therapy programs.
6.6 Regularly evaluates needs and effectiveness of the occupational therapy program and makes revisions as indicated.
6.7 Assists in recruitment and staffing for implementing occupational therapy services.
6.8 Supervises other occupational therapy staff persons.
6.9 Maintains inventories of equipment, materials, and supplies.
6.10 Establishes and updates policies, procedures and forms according to state and federal laws and regulations.
6.11 Plans and implements in-service education programs.
7.0 Major Function: Professional Development/Ethics
7.1 Adheres to the occupational therapy code of ethics.
7.2 Participates in continuing education and professional growth objectives.
7.3 Integrates current professional knowledge with practice.
7.4 Abides by established laws, rules and regulations, and LEA policies.
7.5 Uses clinical educational research.
Evaluator’s Summary Comments:
Occupational Therapist’s Reactions to Evaluation:
Occupational Therapist’s Signature Date
Evaluator’s Signature Evaluator’s Position Date
8/06 Signature indicates that the written evaluation has been seen and discussed and does not imply agreement or disagreement with the evaluation.