D1.Performance Eval Level I FW:Eval & Intervention

Level I Fieldwork Evaluation and Intervention
DEPARTMENT OF OCCUPATIONAL THERAPY
UNIVERSITY OF CENTRAL ARKANSAS

Date * / MM / DD YYYY
Student Name * First Last
Fieldwork Educator Name * First Last
Fieldwork Educator Email Address *
Fieldwork Educator Name (2nd supervisor/evaluator if needed) First Last
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.
Student exhibits a professional image. * 5 4 3 2 1
The student demonstrated a respect for time (arrives on time, begins/ends treatment on time, uses time wisely, etc.) * 5 4 3 2 1
The 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 to show 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, the student demomonstrates the ability to use interview, observations, and standardized assessments to collect data as part of the OT evaluation process. * 5 4 3 2 1
The student documents findings of an assessment and or evaluation appropriately for the setting. * 5 4 3 2 1
The student demonstrates the ability to interpret and report assessment results using appropriate professional written and verbal language. * 5 4 3 2 1
The student developed an intervention plan based upon evaluation findings, appropriate theoretical perspectives, and client needs. * 5 4 3 2 1
Student selects and utilizes appropriate occupation-based and preparatory methods (if needed) for client-centered interventions within the constraints of the practice environment. * 5 4 3 2 1
Student monitors and reassesses, in collaboration with the client, caregiver, family, and significant others, the effect of occupational therapy intervention and the need for continued or modified intervention. * 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 overal 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".

D1.Performance Eval Level I FW:Eval & Intervention

D1.Performance Eval Level I FW:Eval & Intervention

Acknowledgement