ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY

Public Health Department / Community Health Services / WIC Program

Division/Section/Unit

Criteria Based Performance Evaluation

2/19/08

NUTRITION ASSISTANT

Job Title

Employee Name / Service
ACHCSA / Division
PHD / Section
CHS / Unit
WIC Program
Class Title
Nutrition Assistant I/II / Employee Status / Date and Time of Interview
Supervisor’s Name / Circumstances of Supervision and Length of Time

ES = Exceeds Standard MS = Meets Standard RI = Requires Improvement DNMS = Does Not Meet Standard

Supportive documentation is required for ES, RI and DNMS ratings

A corrective plan of action is required for RI and DNMS ratings

Quality of Work

/ ES / MS / RI / DN
MS
  1. Consistently determines client WIC eligibility, including evaluation of residency, income, acceptability of medical referral form/information, medical conditions, psycho-social factors, barriers to good health practices, nutritional need and risk level in accordance with the WIC Program Manual and policy.

  1. Consistently completes WIC Participant Information sheet, and assists clients in completing WIC forms when necessary; issues correct forms to clients; obtains necessary client information; completes and signs forms as required.

  1. Consistently enters accurate and complete information in all ISIS screens,identifies and enters all appropriate risk and intervention level codes in accordance with WIC Program Manual and Alameda County WIC procedures (including IZ and Lead values); and determines acceptability of medical dates on referrals.

  1. Consistentlyrefers or schedules clients identified with level 3 or 4 risks to the Nutritionist according to high risk protocol.

  1. Consistently provides face-to-face nutrition counseling to low risk clients in accordance with the WIC manual and protocols; follows recommended methods/strategies in counseling clients and providing motivation to promote behavior change;works with the client to address needs that are within the scope of program services; selects topics according to nutrition care plan and client feedback;develops measurable nutrition goal(s) with client input; and provides appropriate educational materials.

  1. Consistently maintains and establishes rapport with client.

  1. Consistently makes appropriate program referrals and documents referrals or on the Referral Screen or in the INEP.

  1. Consistently documents nutrition education contacts concisely, completely and accurately on both INEP and Nutrition Ed Document Screens.

  1. Consistently modifies Nutrition Education Plan/Schedule for family according to intervention needs, client feedback, and in coordination with all family members’ Nutrition Education Plans; works with client to schedule acceptable return appointment.

  1. Consistently updates ISIS record with current telephone number and address, at every WIC contact.

  1. Consistently verifies and makes changes as needed in ISIS record to individual prescription, and alternates.

  1. Consistently reviews ISIS record “Holds” and acts on instructions as needed.

  1. (Consistently leads group discussions or presents classes to clients by following class outline. combined w #14)

  1. Consistently leads group education contactspresents classes clearly, following class outline, and in a timely manner according to the pace of the clinic or as required by the subject manner.

  1. Consistently engages clients in active participation by effective use of questions, soliciting answers from the group, willingly answering client questions in a manner easily understood by client, reviewing subject matter and eliciting feedback.

  1. Consistently explains program services and procedures to clients accurately.merged in Customer Service

  1. Consistently prepares food instruments (FI) rx accurately, electronically sends all eligible FI to print list and issues FI accurately.

  1. Consistent checks serial numbers and signatures when issuing FI.

  1. Consistently voids FI and issues appropriate replacement when processing a ‘Void’.

  1. Always locks keyboard when leaving workstation and logs off when leaving workstation for breaks or other extended absences.

  1. As assigned, conducts inventory and submits orders to maintain proper levels of hand-outs/pamphlets and office supplies.

  1. Consistently reviews own work to assure completeness and accuracy. (‘Completeness/accuracy’ referred to in appropriate measures, and difficult for supervisor to observe

  1. Consistently assists with quality assurance tasks as requestedNot a routine NA function (very rare).

  1. Consistently maintains an organized and neat work area/environment.

  1. Participates in community meetings, outreach events, and conferences when appropriate and when approved by Site Manager or Director.

Supportive Documentation and Comments:

Goals for next evaluation period:

Quantity of Work

/ ES / MS / RI / DN
MS
  1. Consistently demonstrates an ability to keep up with clinic pace,monitoring length of counseling sessions so that client waits are minimized and other tasks are not delayed; and maintains productivity that does not add to the workload of co-workers.
/ #21
  1. Consistently serves clients according to established Agency protocol, an average of one WIC participant every 1520 minutes for a certification or follow-up appointment, serving at least an average of 15 individual education contacts per day and 5 minutes for voucher pick-up appointment.

  1. Consistently ensures the completion of assigned work during the workday.

  1. (When needed, assists others in performing tasks within the classification. Mentioned several other places)

Supportive Documentation and Comments:

Goals for next evaluation period:

Job Knowledge

/ ES / MS / RI / DN
MS
  1. Consistently uses established guidelines for nutrition education.

  1. Consistently, demonstrates knowledge of all duties and responsibilities of the Nutrition Assistant classification.

  1. Consistently attends and participates in in-service education or other relevant trainings.

  1. Consistently consults with the supervisor in matters of uncertainty; seeks information necessary for accuate completion of job duties; utilizes other available resources and reference materials to as necessary and to ensure accuracy. (combined with ‘Initiative’ #2

  1. Consistently uses resources effectively.(addressed in #4)

Supportive Documentation and Comments:

Goals for next evaluation period:

Judgment and Decision Making

/ ES / MS / RI / DN
MS
  1. Consistently completes all priority and related tasks on time with little additional assistance required from others; informs manager of progress on projects.

  1. Consistently maintains focus on work assignments during work hours.

  1. Consistently treats clients and co-workers with respect and courtesy even under emotional and occasional hostile situations; attempts to handle conflicts appropriately.Include in Customer Service #3

  1. Always complies with program rules and regulations.

Supportive Documentation and Comments:

Goals for next evaluation period:

Customer Service

/ ES / MS / RI / DN
MS

1.Serves as an agent of ACHCSA by consistently practicing positive interpersonal skills; uses a “patient/client/customer first” approach.

  1. Always maintains confidentiality according to established Agency and, if applicable, departmental policies and procedures.

  1. Always greets patients/clients/customers, families, visitors and others in a courteous, respectful manner; provides assistance in a helpful manner; attempts to handle conflicts or hostile situations appropriately..

  1. Consistently explains program service, procedures and other relevant information in a clear and thorough manner; utilizes appropriate resources to answer questions and follows up on information not readily available.

  1. Follows established telephone protocol, always communicates in a polite and effective manner; accurately records and delivers messages timely and directs inquiries when necessary.

  1. When needed, provides input on improving client services and educational programs. (moved from Initiative)

  1. Consistently demonstrates cultural sensitivity to clients and staff and respect for diversity. (moved from Other Relevant Factors)

Supportive Documentation and Comments:

Goals for next evaluation period:

Interpersonal Relationships

/ ES / MS / RI / DN
MS
  1. Consistently participates as a team member and focuses on meeting the organizational mission statement.

  1. Consistently communicates and collaborates with co-workers and other staff in a cooperative, considerate, respectful and constructive effective manner.

  1. (Consistently interacts and communicates with other staff in the workplace in a harmonious, respectful and effective manner.merge with # 2)

  1. Consistently interacts and communicates with supervisors in a cooperative, respectful and effective manner; accepts direction and constructive criticism.

  1. Consistently accepts direction and constructive feedback. (cut/paste fm Other Relevant Factors)

Supportive Documentation and Comments:

Goals for next evaluation period:

Planning, Initiative, and Time Utilization

/ ES / MS / RI / DN
MS
  1. Consistently demonstrates ability to provide services to clients as the number one priority.

  1. Consistently demonstrates the ability to recognize and deal with priorities. (Addressed in Judgment #1)

  1. Consistently responds to changes in the workload schedule as necessary; assists in other areas in the WIC office, such as fill in with window responsibilities, assist others in performing tasks within the classification; maintain order and stock of materials; work on special projects.

  1. Consistently informs Site Manager of status of assigned projects and meets deadlines.

  1. Consistently coordinates and prioritizes work to maximize efficiency and productivity during the assigned workday.

Supportive Documentation and Comments:

Goals for next evaluation period:

Initiative (Can we delete this section, merge with others?)

/ ES / MS / RI / DN
MS
  1. When needed, assists others in performing tasks within the classification. Merge with Planning and Time Utilizatin #3

  1. Consistently seeks information necessary for accurate completion of job duties; uses reference material to ensure accuracy.Merge with Job Knowledge #4

  1. When needed, provides input on improving client services and educational programs. Move to Customer Service

Supportive Documentation and Comments:

Goals for next evaluation period:

Attendance

/ ES / MS / RI / DN
MS
  1. Consistently arrives on time for work, meetings and off-site appointments, and is ready and available to work at the beginning of the shift.

  1. Always adheres to agency policy regarding lunch and breaks.

  1. Always calls and talks to supervisor or another manager within 30 minutes of the start of shift if late or absent on a given day.

  1. Consistently completes and submits on time a bi-weekly time report, accurately reflecting actual leave balances, and submits leave of absence requests on a timely basis.

  1. Consistently requests approval for vacations at least 2-3 months in advance whenever possible

  1. As needed, consistently requests compensatory time off, leave for non-emergency medical appointments and other short-term leave at least 72 hours in advance whenever possible, and submits Leave of Absence form on a timely basis.

  1. If the need arises to leave early or arrive late, makes request directly to supervisor or designee and submits Leave of Absence form on a timely basis.Already mentioned above

  1. ROSA – is there any way to build in a measure addressing ‘excessive use of sick leave and questionable pattern of sick leave’?

Supportive Documentation and Comments:

Goals for next evaluation period:

Other Relevant Factors (we would like to delete this section)

/ ES / MS / RI / DN
MS
  1. (Assists in other duties as requested by supervisor or as the workflow requires.Mentioned in 3 other places)

  1. Participates in community meetings, outreach events, and conferences when appropriate and when approved by Site Manager or Director.Move to Quality

  1. Consistently demonstrates cultural sensitivity to clients and staff and respect for diversity.Move to Customer Service

  1. Consistently accepts direction and constructive feedback.Move to Interpersonal Relationship

Supportive Documentation and Comments:

Goals for next evaluation period:

Final: 7/1/04 revised 3/072/08

Corrective Plan of Action

A corrective plan of action is required for Requires Improvement (RI) and Does Not Meet Standard (NDMS) ratings. It identifies the problem, how it will be corrected, within what time period and if follow-up is required.

The manager shall complete and insert this form as appropriate in the evaluation report.

Performance Factor:

How It Will Be Corrected:

Employee:

Manager:

Time Period:

Follow-up (if indicated):

EMPLOYEE:This report has been discussed with me. I understand my signature does not necessarily indicate agreement.

______

SIGNATURE TITLEDATE

SUPERVISOR:______

SIGNATURE TITLE DATE

REVIEWER: ______

SIGNATURE TITLE DATE

………………………………………………………………………………………………………………………………………………………………………

COMMENTS:This section is provided for additional comments as are necessary by the above-named individuals.

REBUTTAL PROCEDURES

POLICY

Employee performance evaluations shall include opportunities and procedures for formal written rebuttals and all employees shall be made aware of those opportunities and procedures.

PROCEDURES

  1. The employee being evaluated shall be informed that his/her signature on the evaluation

does not imply either agreement or disagreement with its contents.

2.The employee must submit a notice of intent to file a rebuttal to his/her supervisor within

5 calendar days from the date of the evaluation.

3.The employee has the right to consult with and/or obtain counsel of his/her choice.

  1. The employee must file a written rebuttal with his/her supervisor within 10 calendar days from the date the notice of intent was submitted. Failure to do so shall constitute an abandonment of the rebuttal.
  1. The employee’s supervisor shall, upon receipt of the rebuttal, prepare a written response within 5 calendar days. The supervisor shall affix a copy of the rebuttal to the employee’s performance evaluation.
  1. The employee shall respond to the supervisor’s written response within 5 calendar days.
  1. Should this written response be unacceptable to the employee, a meeting shall be arranged with an appropriate higher level supervisor within 5 calendar days. The employee shall be entitled to have counsel of his/her choice present at this meeting.
  1. The appropriate Agency Personnel Office shall notify the employee, in writing, of the receipt and filing of the rebuttal.

GROUNDS FOR REBUTTAL

POLICY

In an instance where an employee alleges that a performance evaluation is inconsistent with stated purposes of the evaluation program or violates one of the below stated grounds for rebuttal, that employee shall have just cause to file a rebuttal.

GROUNDS

  1. Statements about personality or attitude where there is no connection to a person’s work performance or the work relations in his/her work area.
  1. Unsubstantiated hearsay or vague charges made by fellow employees.
  1. Statements about “unsatisfactory” work performance where there has not been prior informal discussion or prior attempts to define what is expected of the person being evaluated.
  1. The use of absenteeism to automatically downgrade work performance evaluations.
  1. Statements made on the evaluation by a supervisor who is not familiar with the person’s work.
  1. Statements which indicate discrimination on the basis of race, national origin, color, sex, age, political or religious belief, and physical handicap.
  1. Statements of fact alleged by the employee to be incorrect.
  1. Procedural violations which adversely affect a fair and valid performance evaluation.

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