Frontline Supervisor Survey Instrument Report. APPENDIX A: Memo to Accompany Task List and Task List


Dear [clinical manager],

As part of the data collection for the Better Jobs, Better Care Demonstration evaluation, we are preparing to survey staff members who have a role in supervising direct care workers at participating provider organizations. I would like to ask for your help in identifying staff at [name of provider organization] who are responsible for carrying out specific tasks. Attached is a form that will take about 5 minutes to complete. On this form, please indicate the staff member(s) responsible for each task listed.

As you complete the form, keep in mind that the definition of a direct care worker for the Better Jobs, Better Care Demonstration is an individual who provides hands-on personal care as a significant part of their job. Although activities may sometimes overlap, we do not include LPNs or RNs in this definition. Also excluded are workers who help with cleaning, meal preparation and chores, but do not provide personal care.

Once you’ve identified the staff member(s) who performs these tasks for your organization, please send a reply email and include the completed form as an attachment or fax the completed form to my attention at (814) 865-3098. If necessary, you may make copies of the form in order to include all relevant staff. Space is also provided for comments if you would like to further clarify how the tasks on the list are carried out at your organization.

If you have any questions or would like additional information regarding this request, do not hesitate to contact me at (800) 648-3617. Thank you again for your time and assistance.

Jennifer Sheaffer
BJBC MIS and Survey Coordinator
SSRI, Survey Research Center
The Pennsylvania State University
327 Pond Lab
University Park, PA 16802-6201
Tel: 1(800) 648-3617
Fax: 1(814) 865-3098

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
Staff Member Responsible for Tasks
Staff Member Responsible for Tasks
Staff Member Responsible for Tasks
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        

View full report


"FSSinst.pdf" (pdf, 11.09Mb)

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