Northern Humboldt Union High School District
Certificated Nurse Observation Report
Name:
School:
Event Observed:
Observed Period:
Employment Status:  Temporary
MS: Meets Standards
 Probationary 1
PNI: Progress Needs Improvement
Standard One: Organizational and Managerial Skills
o
o
o
o
o
o
o
o
o
o
o
o
o
 Permanent
UPS: Unsatisfactory Progress Toward Meeting Standards
Comments
MS

PNI

UPS

Comments
MS

PNI

UPS

Comments
MS

PNI

UPS

Respects the cultural values of others
Maintains professionalism during interactions with
teachers, parents, students, colleagues and other outside
professionals/agencies
Provides information, counseling and support to
individuals, families, educational teams and others
regarding health issues
Creates successful transitions for individuals through
collaboration and communication with all necessary parties
Assists the student, family, school staff and community in
becoming informed consumers regarding health care
factors such as immunizations, TB testing, insurance,
physicals and the health care system
Standard Three: Understands and Organizes
Subject for Health Education
o
Probationary 2
Devises and maintains an efficient and effective schedule
for meeting the roles and responsibilities of a school nurse
Meets the school district’s requirements for timely record
keeping
Conducts school health needs assessments to identify
current health problems, identify the need for new
programs, and initiate changes in school nursing practices
Develops and implements health policies and procedures in
collaboration with school administrators, the Board of
Health and the Board of Education
Adopts and utilizes available technology, in collaboration
with district I. T. personnel
Evaluates factors related to safety, effectiveness, cost and
availability when choosing between practice options which
result in the same expected client or program outcomes
Completes MAA billing
Completes Free & Reduced qualification and notification
for Food Service program
Standard Two: Creates and Maintains Effective
Environments for General Health
Education
o
o
Date:
Collaborates with the educational team to create
health/nutrition related curriculum
Assists teachers in incorporating a variety of materials,
methods, and advancing technology into academic
instruction/curriculum to achieve health education goals
Uses materials, resources and technologies to make subject
matter accessible to students
Standard Four: Health Assessment and Evaluation
o
o
o
o
o
o
Comments
MS

PNI

UPS

Assesses and evaluates student health
Integrates all results from the evaluation process to develop
diagnostic impressions and to monitor and improve quality
of care
Collaborates with members of the educational team to
synthesize information from the evaluation to determine
health problems, level of severity, impact on learning
and/or eligibility
Develops recommendations for student accommodations
based on health needs
Uses a variety of materials and methods, and incorporates
advancing technology into administrative and therapeutic
tasks
Designs short-term and long-term plans to foster student
learning about their health and wellness
MS: Meets Standards
PNI: Progress Needs Improvement
UPS: Unsatisfactory Progress Toward Meeting Standards
Professional Responsibilities:
Observation:
General:
Comments:
Overall Rating:
 Satisfactory
_______________________________ _________
Evaluator’s Signature
Date
 Needs Improvement
 Unsatisfactory
_______________________________
Certificated SLP Signature*
___________
Date
*Signature does not indicate agreement. Employee may attach a written ten days of receipt of evaluation.