‘Chatham University Master of Occupational Therapy Program Fielowork- Fieldwork Educator Evaluation of Student Performance student ame: ). Pave EN ait Date: Please consider each ofthe items sted below. Use the folowing scale to rate the student's performance for each item: RATING SCALE FOR STUDENT PERFORMANCE: ‘The student’ performance EXCEEDS the expectatlon for 3 LEVEL! fledwork student. Performance i frequentiy above and beyond expectations. ‘The student’ performance MEETS the expectation fora LEVEL eldwork student, Performance is old and consistent. ‘Te student’ performance NEEDS IMPROVEMENT to meet the expectation for @ LEVEL eldwork student. Works ocasionally unacceptable. ‘The student’ performance Is UNSATISFACTORY and requires significant remediation to meet the expectation fora LEVEL ieléwork student. Workis frequently unacceptable PROFESSIONAL BEHAVIOR evel Expectations Needs mprovement Unsatisfactory EXCEEDS. LeveL! Expectations (MEETS. Displays consistent stiendance and punctual ‘Completes assignments on time. z 2 3. Able to agjust to changes in scheduling and eateoad, + Performance is consistent with the American Occupational Therapy Assocation Occupational Therapy Code of Ethics (ROTA, 2010) 5. Adheres to the fieldwork site dres code. 6 Maintoins confidentiality inl fiework interactions ond complies witha facity confidentiality polices and regulations (re, HIPAA, FERPA, et) 7. Recognizes and manages personal stressors in postive and constructive ways "&._ Acceots and follows through on assigned responses. '9._Responds positively to requests fr assistance and works independant as appropriate to the uation. NN =e oe wor, = 10 Demonsatesopetnes to feedback and modifies behavior n responce to fedback, ‘COMMENTS: ae ; Paice wes ene of the mest prefessienal fieldwork stuck DL hee bodeINTERPERSONAL and COMMUNICATION SKULLS Needs Improverent Unsatisfactory “Ti, Demonstrates respact [or persona and cultural differences trough verbal interactions ond non-verbal actions. 12. Recogniues and demonstrates respect for personal space of cents and others. 7 13. Appears comfortable providing approgriate physical contact to lent. 14, Adjusts verbal and non-verbal communication style and approach with cents, fais, and/or staf. 15, Uses accurate professional and/or ly terminology 3s appropriate ZI 16. Uses appropriate non-verbal communication sil ‘COMMENTS: ueveLt event Expectations Needs Improvement Unsatisfactory “7. Adhere: to universal precautions, ely polices and procedures, and basi safety precautions. 78, Able to Mentfy and incorporate relevant safety precautions e. medical dietary, environmental to ensure lent safety 19, Uses proper body mechanics to ensure own safety. ‘COMMENTS:‘COMMAITINENT Yo LEARNING LeveL Unsatisfactory Expectations Needs Improvement EXCEEDS, LEVEL! Expectations (MEETS. 70, Seeks out new learning opportunities, ble to accurately aisess Gwn sks and identify strategies to improve performance 21. Seeks and wses resources (literature, media, nteracton wit others) to supplement fieldwork instruction 1 ‘COMMENTS: PROFESSIONAL REASONING. EXCEEDS. LEVEL Expectations MEETS LEVEL! Expectations ment Unsatisfactory Needs 2 Raees leva questions ina tine and poe appropriot manner 23. Considers alternative ports of view during the reasoning proces. t 2A deifis intervention options ands ble ous ronal 2. Able to recoprize a problems isenly appropriate solution(s) and offer idess for modiiaton COMMENTS: paige asked epprepriele gamatiens Agung bette Urdraterlirg sf he studink’ strangths + nueds, and. He inferwethen Strate yess Sho lots Parpecttat ¢f fre Sbvctnt and prtermcted wetl witr fem [Requirements for passing: NB more than F'item rated as “Unsatisfactory” OR No more than 2 items rated as “Needs Improvement” [rating of "Needs improvement” of “Unsatisfactory” on any italicized tem (6,13, 17,18, 19) wil result in review ofthe student's performance by the AFWC ‘and the student.4 is Xeth bis Neto TR/L Fever Gaior Naps PANT or Rearealon POU enone) Feliverstavaor reer ease PE ‘mbar yes oFemprence Alleghens lerrredeaks Cla Nest Alea hea. Srhcel District Foldwérksite/Organizaton d 415_fast eefroat Dyi ve tome Stead PA 20 Fieldwork Ste Maling Address © Check here if you want the POU certificate to be mailed tothe Fleldwork St maling address indicated above, ‘2 Check here i you want the PDU certificate to be malled to an address other than the Fieldwork Site, Piesse mall the certificate to the address below: