Self Reflection Worksheet - Social Work

	A	B	C	D	E	F
1	Appendix A - Social Work
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3	Name: Date:
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5	Evaluator: Plan Dated: to
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8	Self-Reflection Worksheet on Professional Practice - Social Work
9	Carefully reflect on your teaching performance in all four Domains. Complete the Self-Assessment by using the following descriptions.
10	U. Unsatisfactory N. Needs Improvement P. Proficient E. Excellent
11	Domain 1: Planning and Preparation		U	N	P	E
12	1a.	Demonstrating knowledge of school social work theory and techniques
13	1b.	Demonstrating knowledge of students and of child and adolescent development
14	1c.	Demonstrating knowledge of curriculum and instructional methods relevant to role
15	1d.	Establishing goals and planning for school social work supports appropriate to the setting and the students served and integrated with the general school program
16	1e.	Demonstrating knowledge of state and federal regulations and of resources both within and beyond the school and district
17		Overall Rating for Domain 1
18	COMMENTS/STRENGTHS:
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22	COMMENTS/TARGET AREAS FOR GROWTH:
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26	Domain 2: The Environment		U	N	P	E
27	2a.	Creating an environment of respect and rapport
28	2b.	Establishing a culture for productive communication
29	2c.	Managing routines, schedules and procedures
30	2d.	Establishing standards of conduct and contributing to the culture for student behavior throughout the school
31	2e.	Promoting structures, procedures and organization systems in the learning environment that support students with a variety of needs
32		Overall Rating for Domain 2
33	COMMENTS/STRENGTHS:
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37	COMMENTS/TARGET AREAS FOR GROWTH:
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43	Domain 3: Delivery of Service		U	N	P	E
44	3a.	Assessing, evaluating and communicating student needs
45	3b.	Assisting students and teachers in the formulation of academic, social/emotional and behavioral plans based on knowledge of student needs
46	3c.	Using school social work techniques in individual and classroom programs
47	3d.	Advocating for students and brokering resources to meet needs
48	3e.	Demonstrating flexibility and responsiveness
49	3f.	Responding and intervening in situations of crisis
50		Overall Rating for Domain 3
51	COMMENTS/STRENGTHS:
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55	COMMENTS/TARGET AREAS FOR GROWTH:
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59	Domain 4: Professional Responsibilities		U	N	P	E
60	4a.	Reflecting on practice
61	4b.	Maintaining records and submitting them in a timely fashion
62	4c.	Communicating with families
63	4d.	Participating in a professional community
64	4e.	Engaging in professional development
65	4f.	Showing professionalism
66		Overall Rating for Domain 4
67	COMMENTS/STRENGTHS:
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71	COMMENTS/TARGET AREAS FOR GROWTH:
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75	Overall Rating for All Domains
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