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Supervision Checklist Template

This document provides a template for a supervision checklist that assesses an individual's performance in various areas. The template includes sections for recording the activity details, instructions for how to complete the assessment, examples of assessment areas and behaviors to evaluate with yes/no questions and point values, and sections to record assessment results, comments, total scores, and signatures. The goal is to evaluate behaviors in multiple assessment areas and provide an overall performance score and comments.

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John Job
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356 views3 pages

Supervision Checklist Template

This document provides a template for a supervision checklist that assesses an individual's performance in various areas. The template includes sections for recording the activity details, instructions for how to complete the assessment, examples of assessment areas and behaviors to evaluate with yes/no questions and point values, and sections to record assessment results, comments, total scores, and signatures. The goal is to evaluate behaviors in multiple assessment areas and provide an overall performance score and comments.

Uploaded by

John Job
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Progress Report - www.tools4dev.

org

Supervision Checklist
Activity Details
Name of individual
being supervised

Name of supervisor

Activity

Location

Date

Assessment
INSTRUCTIONS: List each assessment area and the behaviours for each area.
For further information on how to do this see our instructions on how to write
a supervision checklist.

EXAMPLE

Facilitation Skills
Behaviour Yes No
Did the presenter introduce themselves? 1 point 0 points
Did they speak in a clear voice? 1 point 0 points
Did they encourage everyone to participate in the discussion? 5 points 0 points
Did they let people finish speaking, without interrupting or speaking over 2 points 0 points
them?
Do they help the group to keep time? 1 point 0 points

TOTAL _____ out of 10 points


Comments

This template by tools4dev is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. 1
Progress Report - www.tools4dev.org

<Assessment Area 1>


Behaviour Yes No
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>

TOTAL ______ out of <#> points


Comments

<Assessment Area 2>


Behaviour Yes No
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>

TOTAL ______ out of <#> points


Comments

This template by tools4dev is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. 2
Progress Report - www.tools4dev.org

<Assessment Area 3>


Behaviour Yes No
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>
<Insert behaviour question> <Insert <Insert
points> points>

TOTAL ______ out of <#> points


Comments

Conclusion
TOTAL SCORE ______ out of <#> points
Overall Comments

Signatures

Supervisor _______________________

Individual being supervised _______________________

This template by tools4dev is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. 3

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