UNIVERSITY OF SOUTH FLORIDA. COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE studenesname: Haretcia \dotowncye ate:_16(240 [is Course {26 C Semester [fe 41S Assigned unit: _“/S, ‘Number of hours worked on unit; _ [© CLINICAL PRECEPTOR:; ‘Above Average Average Below Average NA Motiyatvon to Learn Gg is = QO oO ia Safety o o Documentation QO Oo oO Professionalism fs a o ce its: ~ e Gonment ne ee 4 BARK MohNodion, umes mgt Preceptor Name: eas (Please Print) Preceptor Signature: STUDENT EVALUATION OF PRECEPTO! Cheek all that apply ‘Above Average Average Below Average Knowledgeable = oO o Encouraged learning oO oO ‘Supportive QO ey ‘Acts as role model a o o Professionalism a oO | Comments: Agree/Disagree with evaluations. ‘Comments (including preceptor feedback): a ical Faculty Signature Student Signature Revised May 2012