F 7.0 (b)

Marin Community College District

 

HEALTH CENTER NURSE PERFORMANCE OBSERVATION FORM

 

 

 

Evaluator will indicate which items appeared during the observation by checking the appropriate line.

 

Check if

Observed                                                                                                           Notes and Comments

 

 

_________ provides information or access to information                                                                                                 

                 regarding health services available on campus or

                 in the community                                                                                                                                         

 

_________ provides information or access to information                                                                                                 

                 regarding mental health facilities when appropriate

 

_________ provides health counseling                                                                                                                            

 

_________ develops working relationships with clients                                                                                                     

 

_________ is attentive to clients                                                                                                                                    

 

_________ attempts to understand clients needs                                                                                                            

 

_________ provides the client with time to express his/her                                                                                               

                 needs

 

_________ provides an opportunity for follow-up meetings                                                                                                

 

_________ protects the privacy of the client                                                                                                                    

 

_________ provides emotional support when appropriate                                                                                                  

 

_________ provides up-to-date health information                                                                                                            

 

_________ provides appropriate forms required by the client                                                                                             

 

_________ provides appropriate medical services as provided                                                                                           

                 by law and District policy

 

 

 

 

______________________________________________________________________________________________________

 

 

Evaluee:  _______________________________________ Date and time visited:  _________________________________

 

 

Signature of evaluator:  ______________________________________

 

 

 

This form is to be attached to the "Evaluation Report" that is signed by the evaluee and the faculty advisor.

 

 

            PONURSE