ࡱ> U@ sbjbj 8h(JMMM8M M4dOO:HOHOHOHOHOHOZZZZ=+[_Sd$eRgwdVQHOHOVQVQwdHOHOdRRRVQHOHOZRVQZRRSSHOO -5 MQpSSd0dShhZRRhhSShhSHOLO6RO,O`HOHOHOwdwd%'%R'sacramento city unified school district EVALUATION: EDUCATIONAL AUDIOLOGIST Name: School or Office: Position:  Rating Scale:Check One:1 Outstanding2 CommendableTemporary3 Satisfactory1st Year Probationary4 Needs to Improve2nd Year Probationary5 Unacceptable3rd Year ProbationaryNA Not ApplicablePermanent 1.Monitors pure tone thresholds of hearing impaired pupils in special education programs and provides information to classroom teachers regarding the use of functioning amplification. 2.Assesses the middle ear function of all the hearing impaired pupils at least annually and more frequently according to the needs of the individual pupils. 3.Monitors the hearing aids and earmolds of these hearing impaired pupils both electroacoustically and by means of listening and speech checks. If possible, the aids should be restored to use. 4.Contacts parents as required to provide information, counseling, assistance and recommendations. 5.Assesses the aided auditory skills of the hearing impaired pupils as needed or requested. 6.Works cooperatively with classroom teachers, resource specialists, nurses and other allied personnel. 7.Executes and prepares such forms, records, and reports as may be called for in the audiologic management of the hearing impaired pupils and other pupils for whom services are requested. 8.Contacts and consults other professionals in the community regarding audiologic management of the pupil as desired by parents, teachers, or administrators. 9.Works cooperatively with principals and other district administrators and supervisors in planning and implementing the educational programs of the schools. 10.Exercises supervision and care over all equipment, furniture, books and supplies entrusted to his/her care and instructs pupils in the proper use and preservation of school properties. 11.Maintains the audiologic equipment (service and calibration). 12.Attends and participates in required inservice training activities. 13.Other duties as assigned. Other Responsibilities Applicable to This Evaluation: 14. 15. 16. Overall Evaluation (Use rating scale 1 - 5, as defined on page 1) Specific Recommendations Made to Employee for Improving Services (Required for any certificated employee who has been rated less than acceptable in the performance of any of the duties and responsibilities listed above.) Comments Regarding Outstanding Performance (Optional) Recommendation: I recommend this employee be: Continued in the service of the district.Released from the service of the district.Reassigned to:Check here if additional material is submitted as part of this evaluation report. (Signed)Principal or Administrator in ChargeDate Employee's Acknowledgment: I have read this report, but my signature does not necessarily signify agreement. I understand that any written statement I wish to make regarding this report will be attached to all copies of it. It is understood that I am accountable only to the extent that I have control over the factors which contribute to the reaching of these goals and objectives. Employees Signature Date Witness's Verification (to be used if employee is unwilling to sign). I certify that a copy of this report was presented to the employee named on the first page on (date). (Signed)___________________________________________________  PAGE 4 01/19/05, Rev. 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