SCPP+FORM+6

Work-Based Learning Evaluation Report

Trainee Supervisor/Mentor Job Title Agency

**__ Directions __** : Evaluate the personal qualities below for your trainee. Score the student by using the numerical key below to mark the appropriate space. __List the specific job tasks that are performed by the student each grading period__. Rate the student’s performance using the numerical key below. Your report will be used in determining a grade and for counseling the trainee. Careful attention should be given so as to present a true picture of your trainee’s work and progress each grading period.

** Personal Qualities/Job Tasks Key: ** Excellent (9-10) Good (6-8) Fair (3-5) Poor (1-2) Unacceptable (0)


 * ** Rating of Trainee for Year __-__ ** ||
 * ==== ** Personal Qualities ** ==== |||||||||||| ** Grading Period **  ||
 * ^  ||  ** 1 **  ||  ** 2 **  ||  ** 3 **  ||  ** 4 **  ||  ** 5 **  ||  ** 6 **  ||
 * ** Attendance: ** || Present and on time ||  ||   ||   ||   ||   ||   ||
 * ^  || Begins work promptly ||   ||   ||   ||   ||   ||   ||
 * ** Appearance: ** Clean, neat appearance, poise, orderly ||   ||   ||   ||   ||   ||   ||
 * ** Dependability: ** Able to work with little supervision, follows instructions, consistent ||   ||   ||   ||   ||   ||   ||
 * ** Leadership: ** Aggressive, eager to learn, resourceful, good judgment, able to inspire others ||   ||   ||   ||   ||   ||   ||
 * ** Thoroughness: ** Accurate, careful, completes work ||   ||   ||   ||   ||   ||   ||
 * ** Ability To Get Along With Others: ** Tactful, friendly, cooperative ||   ||   ||   ||   ||   ||   ||
 * ** Social Habits: ** Good attitude, self-control, honesty ||   ||   ||   ||   ||   ||   ||
 * ** Willingness to Work: ** Works overtime, performs extras ||   ||   ||   ||   ||   ||   ||
 * ==== ** Progressive Job Tasks ** ====

// (List specific job tasks performed from Training Plan. // )
|||||||||||| ** Grading Period **  ||
 * ^  ||  ** 1 **  ||  ** 2 **  ||  ** 3 **  ||  ** 4 **  ||  ** 5 **  ||  ** 6 **  ||
 * ** TOTAL ** (**//Personal//** //**Qualities + Job Tasks)**// ||   ||   ||   ||   ||   ||   ||
 * ** Average: Total ÷Total Possible Points ** ||  ||   ||   ||   ||   ||   ||
 * ** TOTAL ** (**//Personal//** //**Qualities + Job Tasks)**// ||   ||   ||   ||   ||   ||   ||
 * ** Average: Total ÷Total Possible Points ** ||  ||   ||   ||   ||   ||   ||
 * ** TOTAL ** (**//Personal//** //**Qualities + Job Tasks)**// ||   ||   ||   ||   ||   ||   ||
 * ** Average: Total ÷Total Possible Points ** ||  ||   ||   ||   ||   ||   ||
 * ** TOTAL ** (**//Personal//** //**Qualities + Job Tasks)**// ||   ||   ||   ||   ||   ||   ||
 * ** Average: Total ÷Total Possible Points ** ||  ||   ||   ||   ||   ||   ||
 * ** TOTAL ** (**//Personal//** //**Qualities + Job Tasks)**// ||   ||   ||   ||   ||   ||   ||
 * ** Average: Total ÷Total Possible Points ** ||  ||   ||   ||   ||   ||   ||
 * ** TOTAL ** (**//Personal//** //**Qualities + Job Tasks)**// ||   ||   ||   ||   ||   ||   ||
 * ** Average: Total ÷Total Possible Points ** ||  ||   ||   ||   ||   ||   ||

Evaluator’s Signature: Date: _