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This form enables the Employment Services Worker (ESW) to monitor participant attendance and performance. It should be completed each month by the Work Site Supervisor and provided to the ESW by the 5th day of the following month. COMMONWEALTH OF VIRGINIA
VIEW SNAP E&T
DEPARTMENT OF SOCIAL SERVICES
Participant’s Name: _______________ EMPLOYMENT SERVICES PROGRAM
Case#:__________________________ ESW: __________________________ ESW Phone #: ___________________
ATTENDANCE & PERFORMANCE RATING SHEET
DATES AND HOURS WORKED FOR MONTH: 20__ __ Date Hours Date Hours Date Hours Date Hours 1 9 17 25 2 10 18 26 3 11 19 27 4 12 20 28 5 13 21 29 6 14 22 30 7 15 23 31 8 16 24 Total Scheduled/Assigned Hours to Work This Month Times Tardy Comments: Total Actual Work Hours This Month Unexcused Absences
Performance Evaluation (Rating Guide: 0=Poor, 1=Fair, 2=Good, 3=Very Good, 4=Excellent) Knowledge of Assignment
Punct Attitude
Cooperation
Works Well with Others
Safety Habits
Quality of Work
Initiative
Grooming
Accepts Supervision
Overall Performance
List skills participant has mastered
List skills that participant needs to improve
Do you recommend that the participant continues in this activity? Yes No
Why Or Why Not?
Work Site Supervisor Name:
Phone Number:
Work Site Supervisor Signature:
Date:
032-02-1010-03-eng