<p> SCHOOL NURSE PERFORMANCE EVALUATION (For Use by Non-Medical Site Administrators) </p><p>School District ______</p><p>Employee Name Review Date t s r e y o v d r A i e o s o r t e b n e c o N p A a i t f s t u s n a n i S e t t o e c i a c m t e s e n a p n t v a x c o U e E m r e r p c p o x n f m a E r I e m P r o f r e P The School Nurse: 5 4 3 2 1</p><p>Program Management Exhibits leadership in the establishment and maintenance of school health programs which meet existing needs and identifies future needs of the student school, and community.</p><p>Interdisciplinary Collaboration Collaborates with other professionals in assessing, planning, implementing, and evaluating programs and activities to benefit students.</p><p>Health Education Demonstrates competency in the development, promotion, and implementation of health education activities.</p><p>Professional Development Participates in continuing professional education and serves as a resource for or provider of staff development activities.</p><p>Community Health Works effectively with individuals, public and private agencies and other community groups and utilizes community resources to meet student health needs.</p><p>Policies, Statutes, and Regulations Understands and complies with school site and district policy and procedures as well as state statutes and regulations.</p><p>Comments:</p><p>(Adapted from the National Association of School Nurses, Inc. 1993) Employee Signature/Date Evaluator Signature/Date</p>