Occupational Therapist Forms

Document Sample
Occupational Therapist Forms Powered By Docstoc
					                                                                                            ___90-Day          ___Annual
                                  Educational Service District 113
                                   Staff Performance Evaluation
                                      Occupational Therapist

Empl oyee’s Name:
                                    (Please Print)
Evaluator:                                                                        Date:
                                    (Please Print)

I.    Organization and Planning
                                                                                                                 Needs
                                                                                                Satisfactory     Improvement*
Evaluati on of Performance
A. Is punctual and regular in attendance
B. Utilizes work t ime efficiently
C. Demonstrates initiative and good judgment
D. Performs other duties as appropriate and/or directed
Related Comments:**




II.   Interpersonal Relations and Communication
                                                                                                                 Needs
                                                                                                Satisfactory     Improvement *
Evaluati on of Performance
A. Creates an inviting and professional atmosphere
B. Maintains a cordial and effective relationship in meeting the public
C. Demonstrates courtesy and professionalism in all co mmunicat ions
D. Appropriately and effectively co mmunicates with co-workers, ad ministration and the
general public
Related Comments:**




III. Professional Res ponsibilities/Qualities
                                                                                                                 Needs
                                                                                                Satisfactory     Improvement*
Evaluati on of Perfor mance
A. Maintains effective working relat ionships with other employees; works effectively as
a team member; maintains positive attitude
B. Upholds standards of confidentiality
C. Demonstrates willingness to purs ue professional development, train ing and growth
opportunities
D. Observes and promotes safe work practices
E. Demonstrates flexib ility in work assignments and schedule; is availab le for altered work
schedules
F. Demonstrates problem-solving skills and abilit ies
G. Adheres to and promotes ESD 113 Board policies and procedures
Related Comments:**




*A mark in this column requires explanation in the related comments.
**When necessary, it is appropri ate to make related comments on an attached page and to incorporate that
page by reference.
IV.   Knowledge and performance of job responsibilities
                                                                                                             Needs
Evaluati on of Performance                                                                    Satisfactory   Improvement *   N/A
A. Administers occupational therapy procedures and modalities for the purpose of
achieving program objectives.
B. Assesses students fine and gross motor skills and functional abilit ies (e.g. perceptual-
motor, hand functions, motor coordination, sensory development, mus cle strength, etc.)
for the purpose of determin ing program elig ibility and developing reco mmendations for
treatment, appropriate assistive devices and/or school placement.
C. Collaborates with a variety of groups and/or individuals (e.g. parents, teachers,
physicians, administration, maintenance personnel, team members, other professionals,
etc.) for the purpose of commun icating information, resolving issues and providing
services in conformance with established guidelines.
D. Consults with teachers, parents, other personnel and/or outside professionals for the
purpose of providing requested information, developing plans for services, making
recommendations and/or coordinating occupational therapy services with those of other
disciplines.
E. Develops treatment plans, interventions and/or educational materials for the purpose
of remediat ing students’ motor skill deficits and ensuring compliance with state and
federal regulations.
F. Directs/supervises the work of assigned COTA’s fo r the purpose of providing
guidance and ensuring that program object ives are achieved.
G. Facilitates meetings, processes, etc. for the purpose of presenting evaluation results
and expected outcomes, identifying barriers and/or ensuring that state mandates are
achieved.
H. Identifies structural issues for the purpose of removing barriers for students with
physical limitations and/or identifying appropriate assistive technology.
I. Instructs students and staff for the purpose of providing informat ion on medical/
behavioral attributes, use of assistive devices and/or implement ing plans for remed iation
of functional limitations.
J. Interprets medical reports for the purpose of providing information and/or ensuring
that treatment/intervention plans are appropriate.
K. Maintains files and/or records (e.g. progress reports, activity logs, billing infor -
mat ion, treat ment plans, etc.) for the purpose of ensuring the availability of informat ion
as required for reference and/or comp liance.
L. Participates in meetings, workshops, and seminars (e.g. training, IEP’s, team
meet ings, etc.) for the purpose of conveying and/or gathering informat ion.
M. Performs site visits at mult iple work sites including home visits for the pu rpose of
providing direct therapy interventions and assistance as required.
N. Prepares a wide variety of written materials (e.g. activity logs, correspondence,
memos, treat ment plans, Medicaid b illings, reports, etc.) for the purpose of documenting
activities, providing written reference and/or conveying information.
O. Researches resources and methods (e.g. intervention and treatment techniques, assessment
tools and methods, community resources, etc.) for the purpose of determining the approp riate
approach for addressing students functional goals.
P. Responds to inquiries (e.g. parents, teachers, staff, students, etc.) for the purpose of
providing informat ion and/or referral as appropriate.
Q. Transports supplies and equipment to a variety of sites for the purpose of ensuring
the availability of items as needed.
R. Assists other personnel for the purpose of supporting them in the comp letion of their wo rk
activities.
Comments:




*A mark in this column requires explanation in the related comments.
**When necessary, it is appropri ate to make related comments on an attached page and to incorporate that
page by reference.
Conference notes and/or agreements:




Evaluatee’s Signature                                                        Date


Evaluator’s Signature                                                        Date

Signature acknowledges participation in, but not necessarily concurrence with, appraisal conference. Additional comments and/or
recommendations made by the evaluator may be attached. A statement may also be attached by the employee.


Reviewer’s Signature                                                         Date




*A mark in this column requires explanation in the related comments.
**When necessary, it is appropri ate to make related comments on an attached page and to incorporate that
page by reference.

				
DOCUMENT INFO
Description: Occupational Therapist Forms document sample