Personal Care Worker Evaluation

Employee Name:

Type of Evaluation:

Outstanding (5): Consistently exceeds job requirements and essential function
Commendable (4): Frequently exceeds job requirements and essential function
Satisfactory (3): Meets job requirements and essential function
Needs improvement (2): Often fails to adequately meet job requirements and essential function
Unsatisfactory (1): Consistently fails to adequately meet job requirements and essential function.

Follows Agency policy on hand washing guidelines

Follows Agency policy on visit “bag technique”

Follows the Consumer’s service plan as established.

Assists in maintaining a healthful, safe environment.

Plans and prepares nutritious meals per service plan.

Assist with medications ordinarily self-administered as per service plan

Notifies the office of changes to Consumer schedule (days or times)

Completion of adl’s per agency policy.

Encourages the Consumer to be involved in their services.

Performance of Household services per the service plan.

Performance of laundry service as per the service plan.

Notifies the office/supervisor of Consumer changes in situation.

Documentation is accurately and appropriately for every Consumer visit.

Submits weekly paperwork timely.

Maintains a professional appearance while visiting Consumers.

Representation of the Agency in a professional manner to Consumers and outside professionals.

Conducts themselves in a polite, courteous and pleasant manner.

Follows all the Agency’s policies and procedures.

Participates in the QA Committee process as requested.

Notifies Agency of emergencies, sickness, and other imminent occurrences that may affect the caseload asap relative to the event’s occurrence.

Submits written time requests 2 weeks or more in advance of planned time off.

Comments:

Goals:

Employee Signature

Date

Evaluator’s Signature/Title

Date

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