WORK BASED LEARNING - EMPLOYER EVALUATION

STUDENT NAME
DATE
Please evaluate the student in the areas specified
based on current industry based standards.

INTERPERSONAL SKILLS
Interacts appropriately with co-workers
Interacts appropriately with supervisor
Maintains appropriate hygiene and dress
Personal problems do not interfere with work
Uses appropriate social skills
Manages stress on the job appropriately
Is able to cope with workplace problems
Adapts to change in routine
WORK READINESS SKILLS
Demonstrates consistent attendance
Demonstrates punctuality
Reports absences appropriately
Follows job safety and health procedures
Demonstrates ability to learn new tasks
Remains on task until work is completed
Seeks assistance when needed
Demonstrates initiative
Works independently
Follows direction from supervisor/co-worker
Reacts appropriately to constructive criticism
Is able to problem solve tasks/situations
Maintains adequate speed of work
Demonstrates quality of work

CT/Vocational/WBL Forms/WBL Employer Evaluation

WORKSITE
EVALUATOR
Below
Standard

Showing
Growth

Meets
Standard

(Multiple Prompts)

(Verbal Prompts)

(No prompts)

Exceeds
Standard

Not
Applicable

What comments or recommendations do you have concerning the job performance of this student?

What skills could this student improve on to be more successful at this type of work?

What barriers does this student present for continued employment in this field of work?

What comments or recommendations do you have concerning the Community Based Work Program?

Level of Support/Supervision
Check the appropriate level of supervision necessary for the student to perform job tasks/duties.
Very independent

Natural supports of the workplace only

Independent

Structured work setting with natural supports of the workplace only

Semi-independent

Structured work setting with natural supports of the workplace & frequent evaluation by work-based learning staff

Crew/enclave

Work setting with daily support of the work-based learning staff

One/one support

Work setting with one on one support/supervision by work-based learning staff to perform all job tasks

SIGNATURES:
________________________________________
Learning Site Supervisor Signature
Date

________________________________________
Student Signature
Date
(Student Signature denotes review)

________________________________________
Coordinator Signature
Date

________________________________________
Job Coach Signature
Date

CT/Vocational/WBL Forms/WBL Employer Evaluation