CBS Employee Participant Feedback

Your support worker is due for a performance review. Please take the time to assist the Program Manager in giving this employee an effective review by taking the time to fill out the form below.

Your responses are confidential and will be submitted directly to the Program Manager.

See the Community Based Support Worker Job Description.

Employee Feedback CBS Family
Full name of employee being reviewed
Name of reviewer completing form
Please provide the name of the Participant the employee is supporting.
Does your participant attend STAGE?
If the participant is part of the Supported Transition Adult Group Education program, please select "Yes".
Please use the following rating system when reviewing the employee:
Rating 1-Needs Improvement 2-Satisfactory 3-Good

1-Needs Improvement: Performance is below acceptable standards; difficulty setting priorities or attaining goals; does only what is asked; difficulty working with others; slow to grasp understanding of duties; work requires constant follow-up; results fall short of requirements.

2-Satisfactory: Performance meets acceptable standards; good grasp of job responsibilities; attains most goals; normally does only what is asked; may take on new tasks and added responsibilities; results meet requirements.

3-Good: Performance significantly exceeds standards; quality work in a timely fashion; works well with others; motivated to get work done and done well; shows initiative; results usually exceeds requirements.

Performance Item

What are your perspectives on the above employee’s job performance for the past year (not based on the last few months or one incident only)?
Maintains professional relationships.
Creatively implements outlined SMART outcomes.
Participant focused approach
Listens and responds professionally.
Understands participant’s needs and learning style.
Arrives on time and leaves on times
Ability to respond effectively under stress
Communicates clearly.
Encourages and assists independence for the participant.
Assists participants to learn new life skills and maintain current skills.
Provides adequate notice when unable to work.
Makes up for cancelled shift(s) or works at different times to fulfil hours.
Ability to respond to your feedback


Thank you for your assistance.

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North Shore Disability Resource Centre

3158 Mountain Highway

North Vancouver, BC

V7K 2H5

phone: 604-985-5371

fax: 604-985-7594


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United Way member agency

The NSDRC was started by a group of families in 1976. In the years since, we have worked for a "Community for All" by developing and providing community housing, infant development programs, youth groups, community-based services, and information and advocacy.

We are grateful for the opportunity to work, live and play on the unceded territory of the Coast Salish Peoples, including the territories of Musqueam, Squamish, and Tsleil-Waututh Nations.