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
Student demonstrates an understanding of health literacy and the ability to educate and train the client, caregiver, family, and significant others, and communities to facilitate skills in the areas of occupation as well as prevention, health maintenance, health promotion, and safety. * 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".

D1. Performance Eval Level I FW: Eval&Intervention

D1. Performance Eval Level I FW: Eval&Intervention

Acknowledgement