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VIRGINIA DEPARTMENT OF SOCIAL SERVICES Attendance & Performance Rating Sheet

10/24 VOLUME V, PART XXV, APPENDIX II, PAGE 27

ATTENDANCE & PERFORMANCE RATING SHEET

FORM NUMBER - 032-02-1010

PURPOSE OF FORM - This form provides a written means for the ESW to monitor VIEW or SNAP E&T participant’s progress and attendance in a CWEP, WE, PSP or FEP placement on a monthly basis.

USE OF FORM - This form is used by the work site supervisor to record the participant’s attendance and evaluate performance in the CWEP, WE, PSP or FEP position. It may also be completed by the ESW based upon information provided by the employer verbally. The form is also used by the ESW to evaluate satisfactory participation (attendance) and any need for intervention to enhance the VIEW or SNAP E&T participant’s progress. Usage of the forms with FEP placement is optional. The ESW may contact the FEP employee for a verbal update. Information obtained must be noted in the VIEW and SNAP E&T record.

NUMBER OF COPIES - One

DISPOSITION OF COPIES - The original is submitted to the ESW by the fifth calendar day after the report month and becomes a part of the case record.

INSTRUCTIONS FOR PREPARATION OF FORM:

The ESW will be responsible for informing the Work Site Supervisor of their responsibility to prepare the form monthly. A six-month supply of the form may be given to the Work Site Supervisor at the time the agreement is completed. Identifying information should be completed by the ESW prior to giving this form to the Work Site Supervisor.

For CWEP, WE and PSP placements, the ESW will be responsible for informing the work site supervisor of the number of hours the participant will be assigned each month.

All sections of the form need to be completed in their entirety to enable the ESW to evaluate performance and monitor attendance.

The Work Site Supervisor will be responsible for completing, signing, dating, and mailing the form to the agency by the fifth calendar day after the close of the report month.

TRANSMITTAL #35 Employment Services Program Acronyms CWEP Community Work Experience ESP Employment Services Program ESW Employment Services Worker including FSS, FSW, SSS, SSW FEP Full Employment Program PSP Public Service Program SNAP E&T Supplemental Nutrition Assistance Program Education & Training VIEW Virginia Initiative for Education and Work WE Work Experience (SNAP E&T)