MILESTONE, INC.

Habilitation Aide Evaluation

CCI, ICF/DD, DT and Group Home Settings

Name Date Eval.Type: 90 DayAnnual

Date of Hire___/___/___
Check One
TIME USAGE Yes No
1. Takes only paid time off. ______
2. On time to work and leaves on time. ______
3. Only takes breaks as scheduled. ______
For “no” answers, the following is
expected for improvement ______
______
______
TRAINING
Has completed Hab Aide training or is completing training & ______
OJTS within allowed time frame. / Received AdditionalTraining Performance Still Needs Improvement / Needs Additional Training / Performance is Satisfactory / Performance Exceeds Expectations
1. Protects individuals from abuse or neglect at all times and immediately reports any concerns.
2. Talks with individuals politely and positively during all activities.
3. Looks for possible injuries, seizures, changes in behavior that may mean a health problem, reports immediately, ensuring medical attention, & documents.
4. Follows daily routine/classroom schedule all the time notifying supervisor if there is a conflict.
5. Assists individuals in using and maintaining all adaptive equipment including gait belts and walkers safely. Uses lifts safely, if applicable. Includes but not limited to eye glasses, hearing aides, etc.
6. Dresses or assists in dressing assigned individual in his/her own clothing that is clean and neat, and fits. Changes or ensures changing of anyone who is not.
7. Makes sure all individuals are clean, well groomed, and neat at all times(face & hands clean, skin care done, hair clean and styled, teeth clean, breath fresh and nicely shaven).
8. Provides care including bathing, teeth brushing, shaving, hair care, menstrual care, etc. if the individual cannot and does so protecting privacy and showing respect for personal preferences.
9. Does Eating Programs (and documents) or feeds individuals making sure person and area are neat and clean during meal, talking to individuals, and making mealtime pleasant.
10. Follows menus and diets correctly encouraging healthy eating habits and observing for and documenting individual preferences
11. Does group activities as assigned, making sure all individuals are involved andare enjoying activity. Uses praise and encouragement for participation.
12. Conducts individual self-care programs consistently and correctly and documents immediately. Praises successful performance or attempts.
13. Conducts individual social habilitation programs consistently and correctly and documents immediately. Praises successful performance or attempts.
14. Follows BDP’s for all individuals as written and documents immediately. Correctly uses reinforcements.
15. Follows supervisor’s instructions and is courteous to supervisor and co-workers.
16. Toilets or changes individuals as scheduled and documents. Remains with individuals who need help.
17. Cleans up area after meals and activities encouraging individual participation.
18. When done with all assignments, asks for and does additional work.
19. While doing routine household tasks (meal setup, cooking, laundry, household cleaning, kitchen duty, etc.),consistently has individuals doing, helping and/or learning these tasks.
20. Conducts meetings with individuals in their home/program as required focusing on individual participation and expression of preferences and choices.
21. Ensures individual choice in all outings encouraging participation and trying new activities.
22. Follows all procedures on outings including driving in a safe manner at all times and obeying all traffic laws.
23. Before arrival of individuals at home, when individuals are engaged in other activities, or after bedtime, completes any necessary cleaning tasks or other required tasks without being reminded.
24. Ensures individual safety at all times. Completes disaster drills as required. Knows whereabouts of individuals at all times.
25. Understands and promotes Milestone mission statement as evidenced by quality of work (allowing and encouraging individuals to function as independently as possible at all times).
26. Remains at work area leaving only with prior approval of supervisor.
27. Maintains equipment and activity items/supplies in a clean and organized manner and properly stored. Gets replacements and repairs done as needed.
28. Follows all policies and procedures regarding medication administration, if applicable.
29. Teaches skills in and assists with budgeting as needed, recognizing individual choice/control over how money is budgeted/spent. Accurately completes financial documentation.
30. Assists and supports individuals in use of community programs including those related to health and living skills.
31. Assists and supports individuals in participation in volunteering in the community.
32. Assists and supports individuals in maintaining a circle of friends both within the agency and in the community.

For checks in “Needs Additional Training”, the following will be done:

For checks in “Rec’d Additional Training, But Performance Still Needs Improvement”, the following will be done.

Attendance or Training issues will be addressed as follows:

Additional comments/Supervisor

Employee Comments (continue on back if needed)

Supervisor(s) Date

Employee Date

Next Level Supervisor Date

Pe.2DSP3/03