UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE Student's Name: S\W\\SUC pare: 4] 06 [14 Course q Semester, 2 Assigned unit: i E Number of hours worked on unit: CLINICAL PRECEPTOR: ‘Above Average Average Below Average NIA Motivation t Learn is ia} oh Patient Assesment wy o g sus ay o g a Satety ay o a Documentation o 0 a Professionalism a a a Comments: PREAL TO Woe WITH PLEASANT AO CAO TS COOEN, PLE TO BEA BNALLCESE ae 4 . ZING, PREce SO “TO Preceptor Name: _.) {(\L S. MUZSING pecce Pene> (Please Print) e Preceptor Signature: tC.Cg. By cep BULD LOVE s 7 JO RANE GOK STUDENT EVALUATION OF PRECEPTOR: ‘Check all that apply Above Average Average Below Average Knowledgeable Encouraged learning, Supportive ‘Acts as role model Professionalism ooo000: oooo00: (OY WAG cr Greet PICCEPTOY OuAd G worncLLyfl vole moclel Vt HVOUM Gat AGL QV eho) will AOKE A 104 om Tis (CLINICAL FACULTY: iXpuncnle ! Agree/Disagree with evaluations. ‘Comments (including preceptor feedback): nat aca Sinatore by ‘Student Signature Revised May 2012