C2.Student Review Level I FW: OT Process

Level I Fieldwork OT Process Spring 2023
Department of Occupational Therapy
University of Central Arkansas

Student Name * First Last
Date Evaluation Completed * / MM / DD YYYY
Facility Name *
Primary Fieldwork Setting *
If Other, please describe the primary fieldwork setting
Please rate the experience on a scale from 1-5 on the following (make note of ratings to be used most frequently):

5= Far Exceeds Standards:
My performance was highly skilled and self-initiated. Performance was the best that could be expected from any level I fieldwork student.

4= Exceeds Standards:
I frequently completed tasks and activities that exceed requirements/objectives.

3= Meets Standards:
Completed required tasks and activities to meet objectives. This rating reflects good performance for a student at this level. (This rating should be used most frequently.)

2= Below Standards:
My performance is progressing, but need improvement to meet objectives. I did not demonstrate adequate response to feedback. My performance was occasionally unacceptable.

1= Unsatisfactory:
My performance was poor or frequently unacceptable in most required activities and tasks. I did not met the objectives of this experience.

0= I was not given the opportunity to demonstrate.
I exhibited a professional image (e.g. dressed appropriately for the setting, accepted responsibility for personal actions, etc.). * 5 4 3 2 1 0
I demonstrated a respect for time (arriving on time, began/ended activities/tasks on time, used time wisely, etc.) * 5 4 3 2 1 0
I attended all scheduled on-site days and/or made appropriate arrangements for missed days. * Yes No Not Applicable
My behaviors demonstrated active participation, interest, and motivation in learning (e.g. asked for help/feedback appropriately, asked appropriate questions, sought extra learning opportunities, etc.) * 5 4 3 2 1 0
I selected and utilized appropriate occupation-based and client-centered activities within the constraints of the practice environment. * 5 4 3 2 1 0
I interacted with clients and staff appropriately and professionally. * 5 4 3 2 1 0
I demonstrated a respect for diversity. * 5 4 3 2 1 0
I adhered to all safety regulations of the facility related to self and others. * 5 4 3 2 1 0
I adhered to ethics and confidentiality (HIPAA) during interactions with clients, families, and other professionals. * 5 4 3 2 1 0
I asked appropriate questions and produced clinical and written work that incorporated prior knowledge and/or showed higher level assimilation of learned materials. * 5 4 3 2 1 0
Under supervision, I demonstrated the ability to develop and implement contextually relevant individual and/or group interventions to address psychosocial development and/or behavioral health that affect occupational performance. * 5 4 3 2 1 0
I demonstrated the ability to use interview and observations with client(s) to collect data as part of the occupational therapy process. * 5 4 3 2 1 0
Under supervision, I demonstrated the ability to adapt and/or modify processes to reflect the changing needs of the client. * * 5 4 3 2 1 0
I adjusted and demonstrated carryover of my performance based on feedback (feedback from fieldwork educator/supervisor and/or university fieldwork instructor). * 5 4 3 2 1 0
Please discuss the ONE MOST important thing you learned from this fieldwork experience: *
Please discuss the SECOND MOST important/beneficial thing you learned from this fieldwork experience: *
What did you appreciate least about this experience? *
List the resources you used to meet the course objectives for this level I fieldwork experience (e.g. textbooks, evidence-based/scholarly sources, web-based, etc.). *
Do you believe you added value to your fieldwork site? If yes, please explain what particular value you contributed. If no, please explain your rationale. *
Discuss your strengths learned from this fieldwork experience and how this insight will benefit you moving forward in your occupational therapy education and future career. *
Discuss your areas for improvement learned from this fieldwork experience and how this insight will benefit you moving forward in your occupational therapy education and future career.
Please discuss any suggestions you have for improving this Level I Fieldwork experience (site specific): *
What would be your advice to another student who is assigned to the same facility next semester for Level I Fieldwork (Occupational Therapy Process)? *
Additional Comments:
I acknowledge that the person completing this evaluation is the student listed above. Furthermore, I have reviewed this evaluation with the fieldwork educator (site) as deemed appropriate between the site and student.
* Yes No
*NOTE: It is recommended you print or take a screen shot of this evaluation for your records after clicking on "CONTINUE" and before choosing "SUBMIT". You must click SUBMIT for your evaluation to send successfully.

C2.Student Review Level I FW: OT Process

C2.Student Review Level I FW: OT Process

*NOTE: It is recommended you print or take a screen shot of this evaluation for your records after clicking on "CONTINUE" and before choosing "SUBMIT". You must click SUBMIT for your evaluation to send successfully.