Black Hawk County Employee Performance Evaluation Employee : Supervisor: Title: Program Manager School Nursing Dept: Health Dept Title: Evaluation Period: From: To Due Date: Black Hawk County Governing for the Future 2028 Vision Black Hawk County government is transforming itself with new capabilities for effective service to our citizens and greater-good decision making throughout the organization. We stay current with advances in technology and government to assure the best possible service to the public. We work in a culture of collaboration, learning from others successes, and together, we anticipate and adapt to rapidly changing circumstances and demographics, both globally and locally. With others throughout our county and region, we form a safe, thriving community. Motivating Values - Black Hawk County is committed to being: Effective Responsible Collaborative Efficient Innovative Adaptable ************************* Black Hawk County Health Department Mission Statement The Black Hawk County Health Department will promote optimal public health policy through education, advocacy and effective regulatory action for the benefit of all citizens within its service area. Through ongoing assessment of public health conditions, the Department will work to protect community residents from disease and disability, and through provider collaboration and service delivery, will strive to assure access to appropriate prevention and treatment. ************************* (Section A) Black Hawk County Core Responsibilities & Competencies (CORE) Collaboration: Develops cooperation and teamwork while participating in a group of people, working toward solutions which generally benefit all involved parties. Demonstrates teamwork and works in a cooperative and helpful manner Is respectful and courteous when communicating and assisting others Listens to all points of view and finds agreement when working with conflicting individuals or groups. Identifies and pushes for solutions in which all parties can benefit Develops and maintains effective working relationships with co-workers, general public, and vendors/contractors. Consistently demonstrates the fair and equal treatment of others Works to build a sense of common purpose across groups, avoiding a we versus them attitude
Organizational Understanding: Understands the agendas and perspectives of others, recognizing and effectively balancing the interests and needs of one s own group with those of the broader organization. Adapts to organizational changes in a positive manner Complies with Black Hawk County standards of conduct, policies, and procedures Participates in county and departmental meetings Understands and works to support the Black Hawk County Vision Follows established lines of communication Uses the most appropriate channels and cost-effective means in communication and between departments Keeps objectives that are related to county priorities above one s own priorities and the priorities of one s work group Responsible: Able to make moral or rational decisions on one's own and therefore answerable for one's behavior. Demonstrates dependability by being punctual and present for work in a regular and predictable manner at a specified location in order to perform assigned tasks. Demonstrates effective decision-making skills Maintains commitments to fellow county employees, supervisors, general public, and community partners Completes assigned duties within allotted time Establishes integrity by remaining honest and transparent Effective: Productive or capable of producing results. Utilizes resources in ways that consistently produce wise and desired results for the common good Fosters creativity, stimulating openness to new ideas and a passion for learning Recognizes and acts upon opportunities to be more efficient Seeks and shares expertise on best practices Keeps a solution-oriented approach when handling conflict or problems (Section B) Position Specific Duties & Responsibilities #1 Position Specific Duties and Responsibilities Assists the Schools, Outreach, and Clinics Division Manager in overall management of services including staffing, staff supervision, interviewing, hiring, disciplining, performance evaluations, and other services provided.
#2 Position Specific Duties and Responsibilities Assists in developing of goals and objectives, policies, procedures and clinical protocols. #3 Position Specific Duties and Responsibilities Assists in grant management including writing applications, preparing statistical and narrative reports, budget developments and monitoring and attending grant meetings. #4 Position Specific Duties and Responsibilities Works collaboratively with representatives of other agencies, including school administration and personnel to integrate public health services. #5 Position Specific Duties and Responsibilities Represents the Health Department on various committees and coalitions.
#6 Position Specific Duties and Responsibilities Manages school nurses and health assistant staff in the Schools, Outreach, and Clinics Division and responsible for the overall direction, coordination, and evaluation of these staff. #7 Position Specific Duties and Responsibilities Carries out supervisory responsibilities in accordance with the organization's policies and collective bargaining agreements and applicable laws. o Responsibilities include interviewing, hiring, and orienting employees; provide ongoing educational opportunities; planning, assigning, and directing work; appraising performance; disciplining employees; scheduling; addressing complaints and resolving problems. #8 Position Specific Duties and Responsibilities
#9 Position Specific Duties and Responsibilities #10 Position Specific Duties and Responsibilities #11 Position Specific Duties and Responsibilities #12 Position Specific Duties and Responsibilities
(Section C) Prior Year Goal Review Prior Year Goal Review: How well goals set at the last performance evaluation were met. Prior Year Goal #1: List goals and/or objectives for this position or further development as discussed with staffing during last years review. Prior Year Goal #2: List goals and/or objectives for this position or further development as discussed with staffing during last years review. Prior Year Goal #3: List goals and/or objectives for this position or further development as discussed with staffing during last years review. Prior Year Goal Review Summary Overall narrative summary of the employee s prior year s achievements toward indicated goals
(Section D) Overall Appraisal Summary Overall Appraisal Summary Narrative summary of the overall review: Employee comments in reference to the overall appraisal: (use and attached additional sheets if necessary) Employee Signature Date Supervisor Signature Date * Employee s signature is required to indicate the employee has read the performance appraisal and reviewed the job description.
Employee Name (Please Print): (Section E) Employee Growth & Development New Goal Setting, and Growth & Development Planning Achieving goals and/or completing a development plan does not guarantee advancement or a pay adjustment, nor does it constitute an employment contract New Goal Setting: List goals and/or objectives for this position or further development as discussed with the employee Growth & Development Planning: How goals and actions identified above will be accomplished and/or completed during the next year Category: Dates: Comments List any development needs List action timeline and (current or future) reassessment date Growth & Development Goals: Action: List training or education programs, job rotation, or mentoring activity to develop or improve the skill performance. Starting Date Ending or Reassessment Date Employee How can Black Hawk County or your supervisor assist you in your efforts to reach your growth and development goals? Employee Signature Date Supervisor Signature Date