C2.Student Review Level I FW: OT Process 2023

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

Student Name * First Last
Student Email:
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 1-4 on the following:

4 — Exemplary Performance: Demonstrates satisfactory competence in specific skills consistently; demonstrates substantial breadth and depth in understanding and/or skillful application of fundamental knowledge and skills.

3 — Proficient Performance: Demonstrates satisfactory competence in specific skills; demonstrates adequate understanding and/or application of fundamental knowledge and skills. This rating should be used most frequently.

2 — Emerging Performance: Demonstrates limited competence in specific skills (inconsistencies may be evident); demonstrates limited understanding and/or application of fundamental knowledge and skills (displays some gaps and/or inaccuracies). This is an acceptable rating for clinical skills/abilities for this fieldwork experience.

1 — Unsatisfactory Performance: Fails to demonstrate competence in specific skills; performs in an inappropriate manner; demonstrates inadequate understanding and/or application of fundamental knowledge and skills; (demonstrates significant gaps and/or inaccuracies).
I exhibited a professional image (e.g. dressed appropriately for the setting, accepted responsibility for personal actions, etc.). * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
I demonstrated a respect for time (arriving on time, began/ended activities/tasks on time, used time wisely, etc.) * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
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.) * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
I selected and utilized appropriate occupation-based and client-centered activities within the constraints of the practice environment. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
I interacted with clients and staff appropriately and professionally. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
I demonstrated a respect for diversity. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
I adhered to all safety regulations of the facility related to self and others. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
I adhered to ethics and confidentiality (HIPAA) during interactions with clients, families, and other professionals. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
I asked appropriate questions and produced clinical and written work that incorporated prior knowledge and/or showed higher level assimilation of learned materials. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
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. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
I demonstrated the ability to use interview and observations with client(s) to collect data as part of the occupational therapy process. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
Under supervision, I demonstrated the ability to adapt and/or modify processes to reflect the changing needs of the client. * * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
I adjusted and demonstrated carryover of my performance based on feedback (feedback from fieldwork educator/supervisor and/or university fieldwork instructor). * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance 0 - I was not given the opportunity to demonstrate
General comments on supervision (optional):
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 for this Level I psychosocial Fieldwork experience? *
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 2023

C2.Student Review Level I FW: OT Process 2023

*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.