E1.Performance Eval Level I FW:Analysis of OccPerf

Level I Fieldwork Analysis of Human Occupational Performance
DEPARTMENT OF OCCUPATIONAL THERAPY
UNIVERSITY OF CENTRAL ARKANSAS

Date * / MM / DD YYYY
Student Name * First Last
Fieldwork Educator Name * First Last
OT License # and State *
Fieldwork Educator Email Address *
Fieldwork Educator Name (2nd supervisor/evaluator if needed) First Last
OT License # and State
2nd Fieldwork Educator Email Address
Facility Name *
Facility Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Primary Age of Clients *
Select the Primary Setting for this fieldwork experience. *
If "other" Please describe
Please rate the experience on a scale from 1-5 on the following:

5= Far Exceeds Standards:
Performance is highly skilled and self-initiated. Performance is the best that could be expected from any student.

4= Exceeds Standards:
Student frequently completes tasks and activities that exceed requirements/objectives.

3= Meets Standards:
Student completes 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:
Student is progressing, but needs improvement to meet objectives. Student has not demonstrated adequate response to feedback. Performance is occasionally unacceptable.

1= Unsatisfactory:
Work is poor or frequently unacceptable in most required activities and tasks. Student has not met the objectives of this experience.
Number of days missed by student, if any? *
Student exhibits a professional image. * 5 4 3 2 1
Student demonstrates a respect for time (arrives on time, begins/ends treatment on time, uses time wisely, etc.) * 5 4 3 2 1
Student behaviors indicate interest in learning. (e.g. asks for help/feedback appropriately, asks appropriate questions, seeks extra learning opportunities, etc.) * 5 4 3 2 1
Student demonstrates carryover, adjusts performance based on feedback. * 5 4 3 2 1
Student attends all scheduled clinical days. * Yes No
Student interactions with clients and staff are appropriate and professional. * 5 4 3 2 1
Student demonstrates self-directed learning and/or initiative.
* 5 4 3 2 1
Student asks appropriate questions that show incorporation of prior knowledge and/or that demonstrate a higher level of assimilation of learned materials. * 5 4 3 2 1
Student adheres to safety regulations in the practice setting. * 5 4 3 2 1
Student adheres to ethics and confidentiality (HIPAA) during interactions with clients, families, and other professionals. * 5 4 3 2 1
Under supervision, student selects and applies assessment tools with consideration of the client's needs, cultural factors, and contextual factors. * 5 4 3 2 1
Under supervision, student evaluates client's occupational performance in ADL's, and IADL's, using standardized and/or non-standardized screening and assessment tools to determine the need for occupational therapy intervention. * 5 4 3 2 1
Student demonstrates therapeutic use of self, including one's personality, insights, perceptions, and judgments, as part of the therapeutic process (particularly in assessment) in both individual and group interaction. * 5 4 3 2 1
Student demonstrates clinical reasoning to analyze evaluation, synthesize, and diagnose problems related to occupational performance and participation. * 5 4 3 2 1
Under supervision, student interprets and reports assessment results based on the psychometric properties of tests, considering factors that might bias assessment results and in relation to accepted terminology of the profession. * 5 4 3 2 1
Student applies, analyzes and evaluates the interaction of occupation and activity, including areas of occupation, performance skills, performance patterns, activity demands, context(s) and environments, and client factors. * 5 4 3 2 1
Student demonstrates the ability to analyze and evaluate the effects of heritable diseases, genetic conditions, disability, trauma, and injury to the physical and mental health and occupational performance of the individual. * 5 4 3 2 1
Were the student objectives realistic for this fieldwork experience/setting? * Yes No
Please explain your answer from the previous question.
Please rate the student's overall professional behavior * 5 4 3 2 1
Please rate the student's overall performance on skills and abilities. * 5 4 3 2 1
Comments regarding overall performance, including strengths and areas for improvement. *
Acknowledgement
I acknowledge that the person(s) completing this evaluation is/are the fieldwork educators listed above for the student listed above. Furthermore, I/we have reviewed this evaluation with the student.
* Yes No
Thank you for serving as a fieldwork educator in partnership with the University of Central Arkansas Department of Occupational Therapy. In appreciation, you will receive a certificate of service to the email listed above. Please allow 4-6 weeks.

*NOTE: You may print this evaluation after clicking on "CONTINUE" and before choosing "SUBMIT". *You have not submitted until you click "SUBMIT".

E1.Performance Eval Level I FW:Analysis of OccPerf

E1.Performance Eval Level I FW:Analysis of OccPerf

Acknowledgement