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Clinical Supervision Observation Form This form is to be given to the teacher being observed. Attach a copy of team comments and feedback. TEACHER BEING OBSERVED DATE Time or Period Subject Room Team Members I. Pre-Observation Date Time Room Identify the domain and element s that the team will be observing. Explain what you want the team to be looking for within your identified element. Determine if individual team members will be observing different elements or providing multiple perspectives on the same identified aspect. Explain* II. Post-Conference Analysis Attach copies of the written feedback from team members and return to your administrator. Annual Professional Performance Review To be completed by the building administrator Observation form s to be reviewed in administrative post-conference not forwarded to HR Name of Teacher Grade Level Name of Administrator/Building Domain Area s Observed / Lesson Focus Circle Planning Preparation Classroom Environment Responsibilities Instruction Professional Leadership Building Administrator check Met with teacher in pre-observation conference Meeting Date Reviewed / discussed the written lesson plan attach Lesson Date Post-Observation Administrator s Comments Teacher s signature. TEACHER BEING OBSERVED DATE Time or Period Subject Room Team Members I. Pre-Observation Date Time Room Identify the domain and element s that the team will be observing. Explain what you want the team to be looking for within your identified element. Determine if individual team members will be observing different elements or providing multiple perspectives on the same identified aspect. Explain what you want the team to be looking for within your identified element. Determine if individual team members will be observing different elements or providing multiple perspectives on the same identified aspect. Explain* II. Post-Conference Analysis Attach copies of the written feedback from team members and return to your administrator. Explain* II. Post-Conference Analysis Attach copies of the written feedback from team members and return to your administrator. Annual Professional Performance Review To be completed by the building administrator Observation form s to be reviewed in administrative post-conference not forwarded to HR Name of Teacher Grade Level Name of Administrator/Building Domain Area s Observed / Lesson Focus Circle Planning Preparation Classroom Environment Responsibilities Instruction Professional Leadership Building Administrator check Met with teacher in pre-observation conference Meeting Date Reviewed / discussed the written lesson plan attach Lesson Date Post-Observation Administrator s Comments Teacher s signature. TEACHER BEING OBSERVED DATE Time or Period Subject Room Team Members I. Pre-Observation Date Time Room Identify the domain and element s that the team will be observing. Explain what you want the team to be looking for within your identified element. Determine if individual team members will be observing different elements or providing multiple perspectives on the same identified aspect. Explain* II. Post-Conference Analysis Attach copies of the written feedback from team members and return to your administrator.

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