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