Direct Service Provider/Habilitation Aide Evaluation
Intermittent and 24 hour Apartment CILA settings
Name Date Eval. Type: 90 Day Annual
Rec. Add. Trng., Perf. Still
Needs Additional Training
Performance is Satisfactory
Date of Hire___/___/___
TIME USAGE Yes No
1) Takes only paid time off.
2) On time to work and leaves on time.
3) Only takes breaks as scheduled.
For “no” answers, the following is
expected for improvement
1) Protects individuals from abuse or neglect at all times and immediately reports
2) Talks with individuals politely and with enthusiasm during all activities/
3) Looks for possible injuries, seizures, changes in behavior that may mean a
health problem, reports immediately, ensuring medical attention, and charts.
4) Works with assigned individuals within a schedule that is satisfactory to them.
5) Assists individuals in using and maintaining all adaptive equipment including
gait belts and walkers safely. Uses lifts safely, if applicable.
6) Assists individuals in dressing in his/her own clothing that is clean and neat,
and fits. Documents and discusses with supervisor any individual preferences
that interfere with this.
7) Makes sure all individuals are clean, well groomed, and neat at all times(face
and hands clean, skin care done, hair clean and styled, teeth clean, breath
fresh and nicely shaven). Documents and discusses with supervisor any
personal preferences that interfere with this.
8) Monitors and encourages appropriate and healthy diets including special diets
ordered by physician. Documents and discusses with supervisor any problems.
9) Teaches cooking skills and encourages trying new recipes and foods that
promote a healthy diet.
10) Leads group activities and outings as assigned or requested by individuals,
making sure all are involved and are enjoying activity. Uses praise and
encouragement for participation.
11) Does individual programs correctly and charts immediately. Praises
performance or attempts.
12) Uses BDP’s for all individuals as written and charts immediately. Correctly uses
13) Teaches housekeeping skills encouraging maintenance of a clean and neat
living environment. Assists with cleaning as needed and/or assigned.
14) Does what supervisor asks and is courteous to supervisor and co-workers.
15) Cleans up office area and staff apartment as needed.
16) When done with all assignments asks for and does additional work.
17) Teaches laundry skills as needed.
18) Protects individuals from abuse or neglect at all times and immediately reports
19) Teaches skills in and assists with budgeting as needed recognizing individual
choice/control over how money is allocated.
20) Ensures individual choice in all outings encouraging trying new things and
21) Follows all procedures on outings including driving in a very safe manner at all
22) Before arrival of individuals at home, when individuals are engaged in other
activities, or after bedtime, completes any necessary cleaning tasks or other
required tasks without being reminded.
23) Ensures individual safety at all times, obtaining prompt medical help when
needed, and completing reports.
24) Understands and promotes Milestone mission statement as evidenced by
quality of work (allowing and encouraging individuals to function as
independently as possible at all times).
25) Assists and supports individuals in use of community programs related to
health education and living skills.
26) Assists and supports individuals in participation in volunteering in the
27) Assists and supports individuals in maintaining a circle of friends both within the
agency and in the community.
28) Helps structure environment to maximize independent functioning in all possible
29) Remains at work area leaving only with prior approval of supervisor.
For checks in “Needs Additional Training”, the following will be done
For checks in “Rec’d Additional Training, But Performance Still Needs Improvement”, the following will be done.
Attendance or Training issues will be addressed as follows
Employee Comments (continue on back if needed)
Next Level Supervisor Date