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 1-4 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).
Student exhibits a professional image. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
The student demonstrated a respect for time (arrives on time, begins/ends treatment on time, uses time wisely, etc.) * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
The student behaviors indicate interest in learning. (e.g. asks for help/feedback appropriately, asks appropriate questions, seeks extra learning opportunities, etc.) * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
Student demonstrates carryover, adjusts performance based on feedback. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
Student attends all scheduled clinical days. * Yes No
Student interactions with clients and staff are appropriate and professional. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
Student demonstrates self-directed learning and/or initiative. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
Student asks appropriate questions that show incorporation of prior knowledge and/or to show higher level of assimilation of learned materials. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
Student adheres to safety regulations in the practice setting. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
Student adheres 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
Under supervision, the student demomonstrates the ability to use interview, observations, and standardized assessments to collect data as part of the OT evaluation process. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
The student documents findings of an assessment and or evaluation appropriately for the setting. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
The student demonstrates the ability to interpret and report assessment results using appropriate professional written and verbal language. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
How many formal and/or informal assessments was the student able to complete on this fieldwork experience?
Please list the formal and/or informal assessments that the students had the ability to conduct on this fieldwork experience:
Regarding your feedback given to the student on their performance during the assessment process, please state the student's top strength and top area for improvement.
The student developed an intervention/treatment plan based upon evaluation findings, appropriate theoretical perspectives, and client needs. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
How many intervention/treatment plans was the student able to complete on this fieldwork experience?
Regarding your feedback given to the student on the development of an intervention/treatment plan, please state the student's top strength and top area for improvement.
Student selects and utilizes appropriate occupation-based and preparatory methods (if needed) for client-centered interventions within the constraints of the practice environment. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
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. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
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. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
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 * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
Please rate the student's overall performance on skills and abilities. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
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