Appendix C.pdf

December 8, 2020 VHA DIRECTIVE 0730(1)

APPENDIX C

POLICE OFFICERS RECOMMENDATION REPORT TEMPLATE

Evaluation Type: EJ Applicant J Periodic Directed/Special Examination

Name:

Last 4 of Social Security Number:

VA Medical Facility:

Evaluated by:

Date of Evaluation:

Tests Administered:

Include the following note if background information or other collateral were not available:

NOTE: This evaluation is based entirely on the applicant's self-reported history and no background information or collateral information was available for this evaluation. Additional information regarding the applicant's history and behaviors could result in different findings and conclusions.

[For each of the ten dimensions below, select whether the assessment findings indicate that the applicant does, or does nor, meet the functional requirements. Anchors for each dimension are provided at the end of this template; the anchors below can be retained in the text of the final report to orientate the VA medical facility Employee Occupational Health (EOH) Agency Medical Officer review of this report.

Psychological Dimensions for VA Police Officers

Meets Standards

Does NOT Meet Standards

1. Social Competence: Able to communicate with others in a tactful and respectful manner and show sensitivity and concern in one's daily interactions.

2. Teamwork: Works effectively with others to accomplish goals, as well as subordinates' personal interests for the good of the working group and the organization.

3. Adaptability/Flexibility: Able to change gears and easily adjust to the many different, sudden, and sometimes competing demands of the job.

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Psychological Dimensions for VA Police Officers

Meets Standards

Does NOT Meet Standards

4. Conscientiousness/Dependability:

Demonstrates diligent, reliable, conscientious work patterns, and performs in a timely, logical manner in accordance with rules, regulations and organizational policies.

5. Impulse Control/Attention to Safety:

Takes proper precautions and avoids impulsive or unnecessary risky behavior to ensure the safety of oneself and others.

6. Integrity/Ethics: Maintains high standards of personal conduct, including honesty, impartiality, and trustworthiness, and abides by laws, regulations, and procedures.

7. Emotional Regulation/Stress Tolerance:

Able to maiitain composure and stay in control, particularly during time-critical emergency events and other stressful situations.

8. Decision-Making/Judgment Has common sense, "street smarts," and the ability to make sound decisions, demonstrated by the ability to size up situations quickly to determine ard take the appropriate action.

9. Assertiveness/Persuasiveness: Able to unhesitatingly take control of situations in a calm and appropriately assertive manner, even under dangerous or adverse conditions.

10. Avoiding Substance Abuse and Other Risk-Taking Behavior: Avoids participation in behavior that is inappropriate, self-damaging, and can adversely impact organizational functioning.

ANCHORS FOR EVALUATION RATINGS

Meets Standards: No significant concerns were identified in the applicant's or employee's test findings, interview results, or reported history. It is anticipated that any performance problems in this dimension could be resolved through training, experience and/or supervision.

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Does NOT Meet Standards: Evidence from at least two sources of data, or compelling evidence from a single source, indicates it is more likely than not that the applicant does not meet the functional requirements of this dimension at this time.

Conclusion for suitable: Findings from this evaluation reveal no substantial evidence of behaviors or psychological traits expected to interfere with the applicant's ability to safely and effectively perform the functional requirements of the position of Police Officer with the Department of Veterans Affairs.

Conclusion for unsuitable: Findings from this evaluation reveal evidence of behaviors or psychological traits expected to interfere with the applicant's ability to safely and effectively perform the functional requirements of the position of Police Officer with the Department of Veterans Affairs.

Conclusion for indeterminate: Findings from this evaluation were inconclusive in determining whether the applicant would or would not be able to safely and effectively perform the functional requirements of the position of Police Officer with the Department of Veterans Affairs. In the absence of collateral information, a conclusion of suitable or unsuitable cannot be made. This conclusion may be reconsidered if necessary collateral information becomes available.

Evaluator signature:

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