SSB-SHORT SERVICE EMPLOYEE MENTOR

SSE MENTOR INFORMATION

• SHORT SERVICE EMPLOYEE NAME

• MENTOR NAME

• SLIDE TO MENTOR'S EXPERIENCE (YEARS)

• SSE START DATE

  Date

• SSE TENTATIVE END DATE

  Date

• MENTOR HIRE DATE

  Date

• ANSWER THE QUESTIONS BELOW PERTAINING TO THE MENTOR

• DOES THE MENTOR HAVE THE DESIRE, A PATIENT DISPOSITION, AND IS WILLING TO DEVOTE THE NECESSARY TIME TO SUCCEED AS A MENTOR?

  YES

  NO

• DOES THE MENTOR POSSESS THE KNOWLEDGE AND SKILLS IN THE TASK BEING PERFORMED BY THE SSE

  YES

  NO

• WILL THE MENTOR BE AVAILABLE TO PERFORM A MINIMUM OF FOUR OBSERVATIONS ON THE DESIGNATED SSE EVERY MONTH?

  YES

  NO

• WILL THE MENTOR'S SUPERVISOR REVIEW PROGRESS ON A ONTHLY BASIS WITH SSE AND MENTOR?

  YES

  NO

• DOES THE MENTOR AGREE TO COACH, EDUCATE, AND TRAIN THE SSE THE PROPER WAY TO APPLY BEHAVIORAL SAFETY PROCESS?

  YES

  NO

• MENTOR SIGNATURE

  Sign

• SUPERVISOR SIGNATURE

  Sign