UNIVERSITY OF UTAH COLLEGE * HEALTH Division of Occupational Therapy FIELDWORK | OBSERVATION OF STUDENT PERFORMANCE Student's Name: Fieldwork Facility Supervisor's Name: Dates of Fw: Cet QO - 3O) Please check the most appropriate rating: _ fesanccs Professional Behavior Needs Not The student: Outstanding | Adequate | Improvement | Observed 11. Conforms to institution’s dress code. _ K _ 2. Is responsible and dependable in attendance and prompiness, 3. Communicates effectively with other professionalsistaff. Listens and speaks at S ‘appropriate times. . Contributes toward open communication with supervisor. Gives and receives feedback appropriately. x 5. Establishes and maintains therapeutic relationships with clients and their families. 6. Demonstrates professional values and ethics. 7. Maintains the confidentiality of others. 8. Seeks information and asks relevant questions. Uses resources and time effectively. x< _ 3. Follows through with suggestions made by supervisor. x< 10, Seeks challenges and demonstrates enthusiasm for fieldwork experiences. a 71. Demonstrates independence when appropriate. x | 12, Flexible: effectively adjusts to changes; adjusts priorities without difficulty, Related to Educational Objectives | Needs Not The student has: Outstanding | Adequate | Improvement | Observed 13. Developed an increased comfort level interacting with persons who have disabilities, 7 emotional problems, or psychiatric disorders. < ae 14, Described the needs of clients served by the agency/facility. ea 7 45, Demonstrated respect for the values and diversity of persons with disabilities, caregivers, staff and volunteers. x 16. Demonstrated an attitude of inquiry to enhance creativity and problem solving skills 17. Observed staff interactions, assessments andior treatment sessions with agency/facilty clients. < _ 18. Participated in group or individual treatment sessions as appropriate depending on the skill level of the student and the severity of the client's disabilityiliness. < a 79. Observed OTRICOTA role delineation when Cerlified Occupational Therapy Assistants x ” ate employed by the agency/facilityoor of the student noted at this fieldwork: Punchual, inguizahue, grat interactons w/ chents, Lexibe. Areas the aro an ve toward it proving during remaining fieldwork experiences: A . foe ph iF Arak achudy is ipo easy and dosnt a> “ona as antie cl. 6, rading achuities on the Fly, rar a wonder job, on He sotial ee 4° e, Sr our cation AI we we in a a ‘Student Signature ‘Supervisor Signature C) Please give to the student to retum, or mail to: Jeanette Koski, OTR/L ‘Academic Fieldwork Coordinator Division of Occupational Therapy University of Utah 520 Wakara Way Salt Lake City, UT 64108-1290