TEP eee : ow COLLEGE HEALTH Division of Occupational Therapy aa | OBSERVATION OF STUDENT PERFOF Student's Name: Dew) v ers [ow Fieldwork Facility: ‘Supervisor's Name: ui Dates of FW: Please check the most appropri ratin: oe Professional Behavior Weeds The student Outstanding | Adequate | improvement hte. 1s ie G-2615 4. Conforms io insilulon's orpes code. 2: 1s responsible and dependable in alendance and prompiness. “3, Communicates effectively with alher professionalsistaff. Listens and speaks at ‘appropriate times. XK 2 Contbules fer open Cormhieaon wih supervisor. Gives and rases Teeaback appropriately. x Establishes and maintains therapeutic relalanships with clients end their families, ‘Demonstraies professional values and ethics. z 6 7. Mainians the confidentially of cthers '. Seeks infomation and asks relevant questions. Uses resources and time effectively. x bi {Follows through with suggestions made by supervisor. 110. Seeks challenges and demonstrates enlhusiasm for eldwork experiences. 1. Domonstrales independence wien appropriate, 12, Flexible: effectively adjusts to changes; adusts proiles without dificult. Related fo Educational Objectives ‘The student has: Outstanding | Adequate Needs Improvement Wot observed 713. Developed an inoreased comfort level nleracing with parsons who have disabililes, ‘emotional problems, or psychiatric disorders. 4. Deseribed the needs of clients served by the agenyfacily 15, Demonstrated respect forthe values and diversity of persons wih asabilies, caregivers, staff and volunteers. ——_ 76, Demonstrated an atlitude of inquiry to enhance creallvty and problem solving skis 17, Observed staff interactions, assessments andior weatment sessions with agencyifacity ints |18. Participated in group or individual treatment sessions as appropriate depending on the ‘kl level ofthe slucent and the severly of the client's aisabiliyfiness, 18. Observed OTRICOTA role dalinestion when Cerlfled Occupational Therapy Assisianis| ‘are employed by the agency/faciliy 7Strongths ofthe student votfit tieteldnon: Decor WAS vert ntobvatc’ to barr aod Vena Drrgegech VAMglhtit eek ler, fret wore 4ea¢sriiperf- Le ve ppc i beubts een preckec tel sq burclec he. P 5 NE ae ede 2 phlei Nee Hee free Neer Recs ey | f preddivtes, sin piasrstig fee eae! Corttin- Acitional comments: pes ¥ pe be: Cotrinat GQ arQcrament ana fects 4 bg te 9 eee fo ry ASE Grete ger Ss ee. Behn TEBE MBE CPG IL {dal eae uh WMeyo- Buriceem{l 0T Superviedt Signature Jeanette Koski, OTRIL ‘Academic Fieldwork Coordinator Division of Occupatiogal Therapy University of Utah 520 Wakara Way Salt Lake City, UT 84708-1290,