Safety Patrol Feedback (Online Evaluation)
How are things going out at patrol?
Email address
This evaluation is for which day of the week?
This evaluation is for what time of day?
What is the date?
MM
/
DD
/
YYYY
Who is the person filling this survey out?
Evaluators only: Which students showed up on time for their shift? (Don't count volunteers or subs).
Evaluators only: Which students were late or absent?
Evaluators only: Name the subs or volunteers who helped on this shift?
Name someone on the team today who showed TEAMWORK -- sharing tasks like carrying cones, fixing the whiteboard, or getting a shed key.
Your answer
Name someone on the team today who showed CONFIDENCE -- using a loud voice, walking with good posture, asking a question, or giving directions to someone.
Captionless Image
Your answer
Name someone on the team today who showed RESPONSIBILITY -- showing up on time, bringing their own uniform, asking for a sub for a shift they will miss, leaving patrol on time, avoids constantly asking "When are we done?".
Captionless Image
Your answer
Name someone on the team today who showed SAFETY -- pushing dolly safely, lining up backpacks against shed wall, holding the sign carefully etc.
Captionless Image
Your answer
Name someone on the team today who showed HELPFULNESS -- helping someone out of a car, training another patroller, explaining something to an adult supervisor etc.
Captionless Image
Your answer
Name someone on the team today who showed INITIATIVE (doing something without being asked) sweeping the shed, getting the tablet, finding subs for absent patrollers etc.
Captionless Image
Your answer
Name someone on the team today who showed RESOURCEFULNESS (showing creativity; making due with the supplies or people you have on hand)-- assigning each person several jobs because not enough volunteers, using a paper evaluation because the tablet is unavailable, using a zip-tie if the shed lock is lost etc.
Captionless Image
Your answer
Name someone on the team today who showed ORGANIZATION--sweeping the shed, folding extra shirts, pushing backpacks against the shed walls, fixing the white board, stacking the cones etc.
Captionless Image
Your answer
Name someone on the team today who showed ENTHUSIASM--smiling, saying all 4-H's as valet, telling students "Good morning!", leading a chant, using a loud voice as caller etc.
Captionless Image
Your answer
Did any safety patrollers do anything that CONCERNED you during the shift? (Please avoid using specific names of safety patrollers. Tell the teacher the names of students privately).
Captionless Image
Your answer
Did any pedestrians or drivers do anything that CONCERNED you during the shift? (You MAY use names here so long as they are not members of our safety patrol squad).
Captionless Image
Your answer
Thank you for filling out this evaluation! Is there anything else you want to tell the safety patrol coordinator Jennifer Jenkins? (Hint: Make sure that any info. that is an emergency be reported to the principal right away and not just listed in this evaluation.)
Your answer
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This form was created inside of Santa Clara Unified School District. Report Abuse - Terms of Service - Additional Terms