OBSERVATION REPORT FORM
(Certificated Support Staff)
(i.e., Nurses, Therapists, Speech/Language Pathologists, Counselors, Psychologists & Librarians)
APPENDIX J-2
Employee Name:_________________________________ Empl. ID:_____________________
School/Department/Assignment:_____________________________________________________
Evaluator _________________________________________________________________
(please print name)
Date:______________________
Note: this form is to be used as specified in Article XI, Evaluation.
Evaluation Criteria:
Knowledge and
scholarship in special field
Specialized skills
Management of
special and technical environment
The support person
as a professional
Involvement in
assisting pupils, parents and educational personnel
Professional responsibility
Evaluation
Criteria: Knowledge and
scholarship in special field Specialized
skills Management of
special and technical environment The support
person as a professional Involvement in
assisting pupils, parents and educational personnel Professional
responsibility
Narrative Summary:
Summarize, in separately identified sections on an attached sheet (or the reverse side of this form):
1. “Strengths,” with reference to the applicable Evaluation Criteria;
“Area(s) for Improvement,” with reference to the applicable Evaluation
“Summary of pre- and/or post-observation conference(s)”
Employee_________________________________ Evaluator:_________________________
(signature is only an indication of receipt)
Date: ________________________________ Date: ____________________________