ࡱ> U@ bjbj ;bT J"jNjNjN8N N$"FeOO:PPPPPP`[b[b[b[=[3`d$2fRhd&RPP&R&RdPPeJSJSJS&RLPP`[JS&R`[JSbJSTTPO M jNrRdTTe0FeT iR^ iT"" iTPLdP6JSP,P`PPPdd""$)$4S"")sacramento city unified school district EVALUATION: SCHOOL SOCIAL WORKER Name: School or Office: Position:  Rating Scale:Check One:1 Outstanding2 CommendableTemporary3 Satisfactory1st Year Probationary4 Needs to Improve2nd Year Probationary5 Unacceptable3rd Year ProbationaryNA Not ApplicablePermanent 1.Provides social work counseling, therapeutic and educational group work services to families. 2.Provides social work counseling or social group work services to pupils. 3.Provides consultation services to school personnel. 4.Makes appropriate referrals of families to public or private community resources for assistance and works cooperatively with them. 5.Participates in case conferences and works cooperatively with other pupil personnel services staff members, school personnel, and community agencies. 6.Participates as a resource person in school in-service training and program planning. 7.Serves as a source of information for school personnel concerning community resources such as educational, recreational, protective, and therapeutic services available for children and their families. 8.Serves as liaison person between school, family, and community resources. 9.Maintains appropriate case records and provides written reports as required. 10.Provides consultation with and supervision of Pupil Service Workers. 11.Provides psychosocial assessment and diagnosis of behavioral disabilities with recommendation and/or environmental manipulation at the school, home and/or community level with periodic reevaluation. Other Responsibilities Applicable to This Evaluation: 12. 13. 14. Overall Evaluation (Use rating scale 1 - 5, as defined on page 1) Specific Recommendations Made to Employee for Improving Services (Required for any certificated employee who has been rated less than acceptable in the performance of any of the duties and responsibilities listed above.) Comments Regarding Outstanding Performance (Optional) Recommendation: I recommend this employee be: Continued in the service of the district.Released from the service of the district.Reassigned to:Check here if additional material is submitted as part of this evaluation report. (Signed)Principal or Administrator in ChargeDate Employee's Acknowledgment: I have read this report, but my signature does not necessarily signify agreement. I understand that any written statement I wish to make regarding this report will be attached to all copies of it. It is understood that I am accountable only to the extent that I have control over the factors which contribute to the reaching of these goals and objectives. Employees Signature Date Witness's Verification (to be used if employee is unwilling to sign). I certify that a copy of this report was presented to the employee named on the first page on (date). (Signed)___________________________________________________  PAGE 4 01/20/05, Rev. 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