T5-1

Bonita House, Inc.Report of Performance AppraisalPage 1

Name of Employee / Reason for Appraisal
(Regular, Special, Introductory) / Date Completed
Position / Program / Date Due

Supervisor and Employee rate definition. Use space below to describe employee’s strengths and weaknesses. Give examples of work well done.

  1. Exceeds Expectations
/ 2. Meet Expectations / 3. Needs Improvement

A.Work Habits – It is the expectation that employee’s will:

Supv / Empl
  1. Assist others beyond own assignments.

  1. Observe working hours by being punctual to work and meetings.

  1. Observe safety rules especially those in the Injury & Illness Prevention Plan.

  1. Comply with work instructions in a timely manner.

  1. Demonstrate organization of work.

  1. Perform duties in an industrious and energetic manner.

  1. Maintain a personal appearance that is suitable for job.

  1. Maintain a neat work area.

  1. Abide by licensing regulations (includes those re: food storage).

  1. Foster positive and supportive work environment.

  1. Strive to adhere to mission and values of organization.

  1. Write communications effectively and efficiently.

  1. Demonstrate knowledge and adherence to BHI ethical standards.

COMMENTS:

B.Relationships – It is the expectation that employees will be responsive to the needs

of clients and maintain positive, professional relations with:

Supv / Empl
  1. Clients.

  1. Clients Support System.

  1. The Public.

  1. Co-Workers.

  1. Supervisor.

  1. Representatives from other service providers.

COMMENTS:

Bonita House, Inc.Report of Performance AppraisalPage 2

C.Adaptability – It is the expectation that employee’s will:

Supv / Empl
  1. Exercise sound judgment.

  1. Make effective decisions.

  1. Perform in emergencies.

  1. Perform with minimum instructions.

  1. Display flexibility to changing needs of the agency.

  1. Maintain a calm demeanor when confronted with challenging work demands.

  1. Demonstrate ability to be a supportive team member.

COMMENTS:

D.Supervisory Ability – It is the expectation that the supervisor will:

Supv / Empl
  1. Make certain that staff have a clear understanding of their responsibilities.

  1. Follow-through with staff to ensure delegated tasks has been accomplished.

  1. Give constructive suggestions and training to employees.

  1. Show a sincere interest in employees needs

  1. Provide regular on-going supervision.

  1. Evaluate performance of staff to inspire greater achievements.

  1. Effectively seek and obtain ideas from staff to improve agency services.

  1. Demonstrate leadership by projecting enthusiasm, self-confidence and cooperation.

  1. Follow Equal Employment Opportunity Policy.

  1. Maintain a work situation that stimulates the professional growth of staff.

  1. Communicate agency policies and other information to staff.

COMMENTS:

Bonita House, Inc.Report of Performance AppraisalPage 3

E.Clinical Skills – It is the expectation that staff will:

Supv / Empl
  1. Demonstrate a knowledge and application of social rehabilitation principles.

  1. Demonstrate a knowledge and application of dual diagnosis principles and practices.

  1. Demonstrate a knowledge and application of chemical dependency, recovery principles, 12-step and relapse prevention.

  1. Demonstrate a knowledge and application of assessment skills.

  1. Demonstrate a knowledge and application of treatment planning.

  1. Demonstrate a knowledge and application of individual counseling.

  1. Demonstrate a knowledge and application of group skills.

  1. Demonstrate knowledge of diagnoses, signs and symptoms, and appropriate intervention strategies.

  1. Use milieu as a treatment modality.

  1. Maintain openness to clinical feedback from co-workers and supervisor.

  1. Chart within guidelines of timeliness, accuracy and appropriate detail.

  1. Propose new ideas for services.

  1. Demonstrate ability to modify his/her approach to treatment in response to needs of different populations.

COMMENTS:

OVERALL APPRAISAL
Exceeds Expectations / Meets Expectations / Needs Improvement

Performance Objectives:

  1. Review for prior period objectives (list objectives and document degree of completion).

______

  1. Objectives for next review period. (Clarify employee’s and supervisor’s responsibility and include staff development.)

To solidify my anxiety management skills at work, that will support personal equanimity and professional composure in complex and/or stressful time periods.

Bonita House, Inc.Report of Performance AppraisalPage 4

Notes: ______

______

______

______

______

Signed: / Supervisor / (position) / Date
Signed: / Employee / Date
Reviewed by:
Executive Director/Clinical Director / Date

Definitions:

Exceeds Expectations:Answering to all requirements. Work is consistently up to and frequently above the requirements.

Meets Expectations:Produces a desired result. Work is good and acceptable and fulfills standard requirements.

Needs Improvement:Performance is below the standard of performance required for the job.

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