Purpose: To provide the supervisor with an understanding of his/her job performance in relation to the supervisee, to suggest areas for improvement, to permit the student to offer feedback to the supervisor in a written form that is based on a set of clearly and previously established criteria, and to increase the supervisor’s competence as a supervisor.
Performance Level Rating Scale: Based on current assessment and progress of supervisionand expectations of supervisee:
3 – much more of this is needed
2 – it would be desirable to have somewhat more.
1 – it would be desirable to have a little more
0 – this area is satisfactory
Directions:Utilizing the Rating Scale above, place the appropriate number on the lineprovided at the end of each item.
Evaluation Items
The supervisor is able to:
This Supervisor Feedback form is based on that given by Hall-Marley (2001) as an instrument to provide feedback to supervisors on the supervisee’s experience of supervision. The form consists of sections including atmosphere for learning, supervision style, supervision conduct, and supervision impact. It is recommended a supervisor feedback form be used a minimum of four times duringeachyearandideally,morefrequently. Itisatoolinestablishingadialogueandafeedbackloopwhichshouldenhancethe supervisoryalliance.(FoundinAppendicesofFalender,C.A.,&Shafranske,E.P.(2004).ClinicalSupervision: ACompetency- based Approach. Washington, D.C.: APA.)
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