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VI Staff Member Caseload Review: Sample

Download Blank Caseload Review form in RTF (43k)

Staff Name: Carey Hardy Position: VI teacher

Number of Schools Served: 9 Number of Students Served: 10

Date: May 10, 1995 Number of Braille/Dual Students: 3

Directions: Use the information entered on the "VI Staff Member Caseload Profile" to complete this form. Calculate the total time commitment per week. Enter the number of hours in the staff members' work week on line (1). Enter the time commitment per week on line (2). Subtract line (2) from line (1) and enter the number on line (3). That figure represents the number of hours over or under the work week the staff member's caseload requires and may be a positive (under work week)) or negative (over work week) number.

TIME COMMITMENT PER CASELOAD
NUMBER OF HOURS PER WEEK OF:  
Direct Instruction: (a) 12.5 Number of Students: 8
Consultation Only: (b) 3.5 Number of Students: 2
Activities in Support of Instruct: (c) 18  
Travel (service related): (d) 4  
Total Time Commitment/ Week: (e) 38 Number of Students Served: 10
37.5 (1) Total number of hours in work week, excluding lunch
-- 38 (2) Time commitment per week in service to students and work related travel
-.5 (3) Number of hours over or under hours in the work week

Changes to be made (if needed), plans or concerns:

Note: negative answer indicates time needed over work week.

No major changes are needed. The VI supervisor may consult with the staff member to review his schedule. Opportunities for altering the schedule to accommodate the need for an extra half hour per week should be considered.

(a) DIRECT INSTRUCTION: Students receiving direct instruction from VI staff, as specified by ARD committee decision.

(b) CONSULTATION ONLY: Students served by VI staff on a "consultation only" basis, not receiving direct instruction.

(c) ACTIVITIES IN SUPPORT OF INSTRUCTION: All activities in support of instruction delivered as per ARD committee decision: for example, liaison with other school and non-school personnel, developing and preparation of materials, staff development, etc.

(d) TRAVEL (SERVICE RELATED): Estimate the amount of travel to and from students and executing other job related duties.

(e) TOTAL TIME COMMITMENT PER WEEK: Add lines a, b, c, and d.

VI Program Caseload Summary



Staff Name and Position

(# Braille Students)

# of students

direct & consultation

# of schools served

# hours/ wk of direct

instruct.

# hours/wk consultation only

# hrs/wk activities in support of instruction

 # hours/wk

of travel

# hrs/wk

total time commitment per/caseload

# hours in work week

 total

# hours

over or

under








# Braille/Dual		 direct:

consult:



Total #:

                








# Braille/Dual		 direct:

consult:



Total #:

                








# Braille/Dual		 direct:

consult:



Total #:

                
Total # Staff:



# Braille/Dual Students:

 direct:

consult:



Total #:

                
INSTRUCTIONS: Enter information from the "VI Staff Member Caseload Profile" or the "VI Staff Member Caseload Review Form". For each staff member, add the totals of columns 4,5,6 & 7 and enter the total in column 8. Subtract the figure in column 8 from the figure in column 9 to arrive at the time commitment per week over or under the staff member's work week required by his/her caseload. Enter that figure in column 10 preceded by a plus or minus. (See sample)


VI Program Caseload Summary: Sample
Staff Name and Position

# of students

direct & consultation

# of schools

served

# hours

per/wk

of direct

# hours

per/wk

consultation

# hrs/wk

activities in

support of

 # hours

per/wk

of travel

# hrs/wk

total time commitment

# hours in work week

 total

# hours

over or
Hardy, Carey

 direct: 8

consult: 2

 9 12.5 3.5 18 4 38 37.5 .5 hr over
Williams, Tammy

 direct: 2

consult: 12

 14 4 20 10 5.5 39.5 37.5 2 hrs over




direct:

consult:

                
Total # Staff: 2

# Braille/Dual Students: 4

 direct: 10

consult: 14

 23 schools

 16.25 23.5

 28 9.5 77.5 75 2.5 hrs over
INSTRUCTIONS: Enter information from the "VI Staff Member Caseload Profile" or the "VI Staff Member Caseload Review Form". For each staff member, add the totals of columns 4,5,6 & 7 and enter the total in column 8. Subtract the figure in column 8 from the figure in column 9 to arrive at the time commitment per week over or under the staff member's work week required by his/her caseload. Enter that figure in column 10 preceded by a plus or minus. (See sample)


Proposed VI Staff Caseloads

DATE: COMPLETED BY:
Staff Name and Position # of students

direct & consult

 # of schools

served

 # hours

per/wk

direct

 # hours

per/wk

consult.

 # hours

per/wk

in supp.

 # hours

per/wk

of

 # hours

in

work

 total

# hours

over or




#		 direct:

consult:




#		 direct:

consult:




#		 direct:

consult:




#		 direct:

consult:




#		 direct:

consult:




#		 direct:

consult:
TOTALS:

# Braille/Dual Students

 direct:



consult:

2







3







4







5







6







7







8







9


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Last revision: July 30, 2002
programs/caseload-review-sample.htm