Member Name
Staff Member Name
1 = Needs Significant
Improvement 2 = Needs Improvement 3 = Average
Area of Development
Rating
Comments
Dependability - Attendance, punctuality, accepts
responsibility, follows instructions
0
1
2
3
4
5
Mental Alertness/Attentiveness - interest in
site and service, eager to learn, ability to learn and remember
methods and procedures
0
1
2
3
4
5
Leadership - Assertive, imaginative, enthusiastic,
good judgment
0
1
2
3
4
5
Initiative - Ability to develop constructive
ideas, keeps busy, consistent, serves without supervision
0
1
2
3
4
5
Thoroughness - Accurate, completes tasks, takes
care of equipment, practices safety, handles supplies efficiently
0
1
2
3
4
5
Personal Appearance - Neat, good hygiene,
0
1
2
3
4
5
Manners - Courteous, considerate, appreciative,
0
1
2
3
4
5
Ability to get along with others
- Friendly,
0
1
2
3
4
5
Self Confidence - Does the member have
0
1
2
3
4
5
Overall Performance Rating
0
1
2
3
4
5
Please
answer or comment on the following:
The most significant contribution that the
member made to your program:
Suggestions for strengthening the partnership
Additional Comments
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