ࡱ> >@=g m$bjbj y2r\r\mZZ$ .....   $"$     .. .. :W.jT:C {0 M V%V%WV%W$              V%         Z> : PERALTA COMMUNITY COLLEGE DISTRICT FACULTY OBSERVATION FORM (For Health Discipline Observers) COLLEGE NURSE Name of COLLEGE NURSE:______________________________________________ College____________________________ Semester______________ Acad. Yr.___________________ Name of Observer_____________________________________________ Date___________________ Appropriate input regarding the Evaluee is encouraged through the appropriate representatives on the Committee. Individuals wishing to participate in the evaluation process should have direct knowledge of the College Nurse=s skills (e.g. have worked with or observed the College Nurse in committee work, department meetings, student contact, public contact, etc.). Please comment on the following: 1) The College Nurse demonstrates responsibility and accountability for day-to-day operation of the Health Services Center. 2) The College Nurse makes timely, effective decisions about provision and scope of health services provided, budget, and personnel. 3) The College Nurse demonstrates knowledge of the Nurse Practice Act in the following nursing areas: a) assessments b) plans c) interventions d) evaluations. 4) The College Nurse demonstrates nursing assessment, plans, interventions and evaluation based on the student/staff presenting problem. 5) The College Nurse maintains currency in the field of nursing as well as in public health issues and practices applicable to the community college population. 6) The College Nurse demonstrates sensitivity to diversity of staff and students (including ethnicity, gender, disability, religion, age, sexual orientation). 7) The College Nurse demonstrates knowledge and utilization of appropriate community resources. 8) The College Nurse communicates effectively (both oral and written). The College Nurse demonstrates leadership qualities in Health Science activities on and off campus. The College Nurse encourages an environment conducive to collegiality. Additional Comments: OVERALL PERFORMANCE RATING: ____SuperiorBsurpasses requirements; exceeds expectations _____SatisfactoryBmeets all standards of excellence as described in the policy ____Below StandardsBdoes not consistently meet requirements ____UnsatisfactoryBdoes not meet requirements; ineffective Observer: Date: _______________ Evaluee: ___________________________________________________ Date: _________________ The evaluees signature on this form does not constitute acceptance of this evaluation. 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