Frontline Supervisor Survey Data Collection Report. APPENDIX A: Supervisor Task List

Supervisory Tasks List
Provider Organization Name:
Under the name of each staff member listed, please put an X next to the tasks they perform. If you need more space to write in the staff members who are responsible for these tasks, you can copy this form.
Tasks Staff Member Responsible for Tasks
Name:
Title:
Staff Member Responsible for Tasks
Name:
Title:
Staff Member Responsible for Tasks
Name:
Title:
Staff Member Responsible for Tasks
Name:
Title:
Act as a mentor to DCWs        
Ensure that DCWs are giving proper care to clients/residents        
Schedule DCWs        
Initiate disciplinary action        
Document DCW performance problems        
Provide feedback (positive or negative) to DCWs on job performance        
Recommend training for DCWs        
Conduct on-the-job clinical training activities        
Directly respond to job concerns raised to DCWs        
Comments:

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