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: CUESTA COLLEGE
Health Services Faculty
DIVISION TENURE COMMITTEE / Peer Review Committee Evaluation Form
The processes and procedures that govern all faculty evaluations are set forth in Article VII of the District/CCFT Collective Bargaining Agreement (CBA). To find the CBA, point your browser to http://ccft.org/contract.htm for the on-line contract. The processes and procedures that govern all faculty evaluations are set forth in Article VII of the District/CCFT Collective Bargaining Agreement (CBA). To f i n d t h e C B A , p o i n t y o u r b r o w s e r t o h t t p : / / c c f t . o r g / c o n t r a c t . h t m f o r t h e o n - l i n e c o n t r a c t .
E m p l o y e e : F O R M T E X T S e m e s t e r : F O R M T E X T F O R M C H E C K B O X R e g u l a r T e n u r e - T r a c k F O R M C H E C K B O X R e g u l a r
F O R M C H E C K B O X T e n u r e - t r a c k - H o w m a n y s e m e s t e r s t a u g h t a t C u e s t a : F O R M T E X T
F O R M C H E C K B O X T e m p o r a r y F O R M C H E C K B O X F u l l - t i m e F O R M C H E C K B O X P a r t - t i m e - I f p a r t - t i m e , h o w m a n y s e m e s t e r s t a u g h t a t C u e s t a : F O R M T E X T
F O R M C H E C K B O X T e m p o r a r y w i t h o u t a s s i g n m e n t r i g h t s - H o w m a n y s e m e s t e r s t a u g h t a t C u e s t a : F O R M T E X T
E v a l u a t o r ( s ) : O b s e r v a t i o n D a t e : T i m e : R o o m # : C l a s s : S e c t i o n : F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T I N S T R U C T I O N S F O R E V A L U A T O R S :
1 . T h e a t t a c h e d f o r m s a r e t o b e u s e d i n t h e e v a l u a t i o n o f t h e p e r f o r m a n c e o f a r e g u l a r , t e n u r e - t r a c k , o r t e m p o r a r y f a c u l t y m e m b e r .
2 . A l l i n s t r u c t i o n a l f a c u l t y a r e t o b e e v a l u a t e d p u r s u a n t t o S e c t i o n s I , I I , I I I , I V , a n d V. Sections IX (Progress on Previous Plan for Improvement) and VI (Plan for Improvement) are to be utilized only when it is applicable to the faculty member who is being evaluated. If a plan for improvement exists, the Dean/Director will review the previous evaluation, including the plan for improvement (7.12.1.1).
3. The Division Tenure Committee/Peer Review Committee, the Division Chair or managers faculty designee, and the faculty member being evaluated review and sign the performance narrative review sheet. A copy of the completed and signed evaluation must be given to the faculty member being evaluated during the post-evaluation conference meeting.
4. The Division Tenure Committee/Peer Review Committee must submit one composite evaluation form representing the committees consensus to the Division Chair (or managers faculty designee where there is no Division Chair). Section II should be completed by the Division Chair (or managers faculty designee where there is no Division Chair) in consultation with the chair of the Division Tenure Committee/Peer Review Committee, and then the completed evaluation will be combined with the dean/directors evaluation.
5. The term Disagree is synonymous with the contractual term Needs Improvement, and the term Strongly Disagree is synonymous with the contractual term Unsatisfactory (7.12).
Strongly agreeThis rating implies that the individual's performance reflects the highest degree of productivity and effectiveness. This rating should be used to differentiate specific criteria where the individual has demonstrated exceptional ability that is especially noteworthy or markedly apparent.Agree This rating implies that the individual's performance consistently meets the standards for the given criteria. The individual is consistently effective and productive.Somewhat agreeThis rating implies that the individuals performance often meets the standard. The individual is effective and productive.Disagree
(needs improvement)This rating implies that the individual's performance partially meets the standards for the given criteria. There are areas of deficiency or ineffectiveness; and it is expected that with increased attention to those areas, the individual's performance will subsequently meet the standards.Strongly disagree
(unsatisfactory)This rating implies that the individual's performance has failed to meet the standards for the given criteria. A considerable deficiency or lack of effectiveness is observed. SECTION I: Peer to Peer Evaluation of Health Services Faculty
(Please mark N/A for any of the items that do not apply)
1. This nurse is prepared and organized.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
2. This nurse presents health information and student education clearly and appropriate to assessment.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
3. This nurse shows respect for students in a non-judgmental manner.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
4. This nurse assists students in a confidential and professional manner.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
5. This nurse demonstrates currency and appropriate depth of knowledge in discipline.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
6. This nurse encourages student questions regarding their health assessment..
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
7. This nurse provides appropriate assessment, treatment, counseling, information and referrals for student health related issues.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
8. This nurse completes appropriate documentation in the student health chart in a timely manner. This documentation
should include a brief student history, physiologic findings, nursing assessment and the treatment plan.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
9. This nurse teaches students to appreciate different perspectives on health related issues and problem solving methods.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
10. This nurse protects privacy of information and confidentiality of student health medical records per regulatory
guidelines.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
SECTION II: Division Chair or Manager's Faculty Designee Evaluation of Faculty
(Please mark N/A for any of the items that do not apply. Statements 1-9 should be done in consultation with Chair of Evaluation Committee)
1. This nurse maintains currency in ones academic field and faculty service area (professional development).
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
2. This nurse participates in professional activities related to the area of specialization and to pedagogy (professional development).
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
3. This nurse maintains a productive working relationship with students.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
4. This nurse addresses student concerns/academic needs in a timely and constructive manner.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
5. This nurse is regularly available for help during posted office hours (not required for part-time instructors).
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
6. This nurse adheres to the approved catalog course outline.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
7. This nurse respects confidentiality of information from and about students.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
8. This nurse treats students respectfully.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
9. This nurse begins and ends class on time.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
10. This nurse communicates civilly with other faculty and staff in the division/service area.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
11. This nurse works collegially with other faculty and staff in the division/service area.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
12. This nurse attends required division meetings.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
13. This nurse meets divisional and/or college-wide committee/governance obligations (see Article V of current CCFT contract).
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
14. This nurse meets divisional and college obligations on time (e.g., textbook orders, flex contracts, grades, early alert,
schedules, reports, and requisitions).
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
15. This nurse maintains the scheduled days and class/service hours.
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
16. This nurse gives final exams in accordance with the official schedule unless permission has been received from area Dean or Director to do otherwise (not applicable to faculty not teaching classes).
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
17. This nurse shares in the divisional workload (not applicable to part-time faculty).
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
18. This nurse maintains educational and professional contacts with the community when relevant to professional commitments (not applicable unless specifically required by law or job description).
1. FORMCHECKBOX strongly agree 2. FORMCHECKBOX agree 3. FORMCHECKBOX somewhat agree 4. FORMCHECKBOX disagree 5. FORMCHECKBOX strongly disagree 6. FORMCHECKBOX N/A
SECTION III. ASSESSMENT OF STUDENT EVALUATIONS
Provide an overall assessment and interpretation of the student evaluations. Written comments are required.
FORMTEXT
S E C T I O N I V . A S S E S S M E N T O F P R O F E S S I O N A L D E V E L O P M E N T
P r o v i d e a n o v e r a l l a s s e s s m e n t o f r e c e n t p r o f e s s i o n a l g r o w t h a c t i v i t i e s . W r i t t e n c o m m e n t s a r e r e q u i r e d .
F O R M T E X T
S E C T I O N V . A S S E S S M E N T O F I N S T R U C T I O N A L M A T E R I A L S
P r o v i d e a n o v e r a l l a s s e s s m e n t i n c o n s i d e r a t i o n o f c o u r s e s y l l a b i , g r a d e d e x a m s o r p a p e r s , w o r k s h e e t s , h a n d o u t s , e t c . W r i t t e n c o m m e n t s a r e r e q u i r e d .
F O R M T E X T
S E C T I O N V I . P R O G R E S S O N P R E V I O U S P L A N F O R I M P R O V E M E N T . A p p l i c a b l e o n l y w h e n t h e p r e v i o u s o v e r a l l e v aluation was Disagree (Needs Improvement) or Strongly Disagree (Unsatisfactory).
This section to be assessed by the Division Tenure Committee/Peer Evaluator.
FORMCHECKBOX Check here if a plan for improvement exists and has been reviewed by the committee.
PROGRESS ON PREVIOUS PLAN FOR IMPROVEMENTStrongly AgreeAgreeSomewhat AgreeDisagree
(Needs Improvement)Strongly Disagree
(Unsatisfactory)N/AShows progress in meeting goals and objectives for improving performance established in the previous evaluation.formcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX
Comment fully and specifically, justifying sections previously marked as Disagree (Needs Improvement) or Strongly Disagree (Unsatisfactory). Attach additional pages if necessary.
COMMENTS:
FORMTEXT
S E C T I O N V I I . O V E R A L L A S S E S S M E N T
( A l l f a c u l t y m u s t b e e v a l u a t e d i n t h i s s e c t i o n )
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(Unsatisfactory)N/AThis instructors performance in most, if not all areas of assessment is satisfactoryformcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX formcheckbox FORMCHECKBOX
SECTION VIII. FACULTY PERFORMANCE NARRATIVE REVIEW
Comment fully and specifically, justifying the overall evaluation. A summary of the Division Tenure Committees/peer review committees findings and recommendations should be described below or attached. Comments shall include a statement of assessment of Section VII. Attach additional pages if necessary.
Written comments are required for a minimum of 1 of the 3 areas below.
Commendations:
FORMTEXT
C o n s i d e r a t i o n s :
F O R M T E X T
R e c o m m e n d a t i o n s :
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S E C T I O N I X . P L A N F O R I M P R O V E M E N T . A p p l i c a b l e o n l y w h e n t h e o v e r a l l e v a l u a t i o n i s D i s a g r e e ( N e e d s I m p r o v e m e n t ) o r S t r o n g l y D i s a g r e e ( U n s a t i s f a c t o r y ) .
F O R M T E X T
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h5@ 5U\ , ECKBOX Student Evaluations
Applicable Signatures:
DTC/Peer Evaluator Date DTC/Peer Evaluator Date
DTC/Peer Evaluator Date
Division Chair Date
(If no Division Chair, manager's faculty designee or chair of DTC/Peer Committee)
Faculty Member Date
The above-signed individuals have read and discussed this evaluation. Faculty member's signature acknowledges receipt of a copy of the evaluation document. It does not necessarily signify agreement. The faculty member has ten days to respond in writing to this evaluation, if desired.
PAGE 1
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