SUPERVISEE PERFORMANCE EVALUATION

Supervisee: ___________________________________________________________________________

Period Started: ________________________________________________________________________

Supervisor: ___________________________________________________________________________

Please rate the supervisee’s performance for the period indicated. Rate the supervisee in comparison with the
average supervisee at the same level of training. Include comments at the bottom when assigning Below or
Well Below standard ratings. Review this evaluation with the supervisee and have the supervisee sign at the
bottom.

Circle one:

1 = Well below standard 2 = Below standard 3 = Standard 4 = Above standard

5 = Well above standard NA = Not applicable

Professional Practice
a. Attendance/Punctuality 1 2 3 4 5 NA
b. Responsiveness to supervision 1 2 3 4 5 NA
c. Relations with staff 1 2 3 4 5 NA
d. Relationships with clients 1 2 3 4 5 NA
e. Ethical practice 1 2 3 4 5 NA
f. Verbal communication 1 2 3 4 5 NA
g. Written communication 1 2 3 4 5 NA
h. Treatment team participation 1 2 3 4 5 NA
i. Understanding multicultural
Issues/individual difference 1 2 3 4 5 NA
j. Seeks supervision when needed 1 2 3 4 5 NA
k. Seeks consultation when needed 1 2 3 4 5 NA
l. Initiative/independence 1 2 3 4 5 NA
m. Judgment/maturity 1 2 3 4 5 NA
n. Open to personal development 1 2 3 4 5 NA

Assessment Skills
a. Knowledge of instruments and methods 1 2 3 4 5 NA
b. Formulation of referral questions 1 2 3 4 5 NA
c. Test administration:
Intellectual 1 2 3 4 5 NA
Neuropsychology 1 2 3 4 5 NA
Personality 1 2 3 4 5 NA
Projectives 1 2 3 4 5 NA
d. Test interpretation:
Intellectual 1 2 3 4 5 NA
Neuropsychology 1 2 3 4 5 NA
Personality 1 2 3 4 5 NA
Projectives 1 2 3 4 5 NA
e. Rapport with clients 1 2 3 4 5 NA
f. Report writing 1 2 3 4 5 NA
g. Provides feedback to client 1 2 3 4 5 NA
Intervention Skills
a. Individual therapy skills 1 2 3 4 5 NA
b. Group therapy skills 1 2 3 4 5 NA
c. Rapport/empathy in therapy 1 2 3 4 5 NA
d. Developing a clear treatment plan 1 2 3 4 5 NA
e. Intervention based on theory/research 1 2 3 4 5 NA
f. Intervention based upon client needs 1 2 3 4 5 NA
g. Evaluates progress regularly 1 2 3 4 5 NA
h. Addresses termination issues 1 2 3 4 5 NA

Other
a. _______________________________ 1 2 3 4 5 NA
b. _______________________________ 1 2 3 4 5 NA
c. _______________________________ 1 2 3 4 5 NA

Overall Performance 1 2 3 4 5 NA

COMMENTS:

________________________________________ ________________
Supervisor Signature Date

This evaluation has been reviewed with me. I agree____ disagree______ with the evaluation.

________________________________________ ________________
Supervisee Signature Date