School Nurse Performance Evaluation Form
For Use by Non-Medical Site Administrators
Employee Name
First Name
Last Name
School District
Review Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
The School Nurse:
Rows
Superior Performance
Above Expectations
At Expectations
Needs Improvement
Unsatisfactory Performance
Competent in the planning, promotion, and implementation of health education programs.
1
2
3
4
5
Participates in ongoing professional education and provides or serves as a resource for staff development activities.
6
7
8
9
10
Assesses, plans, implements, and evaluates programs and activities for the benefit of students
11
12
13
14
15
Meets student health needs through collaborating successfully with individuals, public and private agencies, and other community groups.
16
17
18
19
20
Understands and follows the policies and procedures of the school site and district, as well as state statutes and regulations.
21
22
23
24
25
Comments:
Employee Signature
Evaluator Signature
Submit
Should be Empty: