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Fieldwork Performance Evaluation
For The Occupational Therapy Student
a. Shayna Kos SIGNATURES:
NAME: AST) tr (woot) HAVE READ THIS REPORT.
University of Utoh.
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semture dé S100
FIELOWORK SETTING:
Anterrrountoun Hedical Center _
Ti OF ORGANZATIONFACILTY ‘NUNEER OF PERSONS CONTRIBUTING TO THS REPORT
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ADDRESS: (STREET OR PO BOX)
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TyPe OF FIELDWORK PRINT NAMEICREDENTIALSIPOSITION
onDER oF PLaceMeNT(D) 2 8.4 ouToF@2 34
me YH ow 31H
ATES OF PLACEMENT ‘SIGNATURE OF RATER #2 (FF APPLICABLE)
490
NUMBER OF HOURS COMPLETED PRINT NAMEICREDENTIALSPOSTION
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FINAL SCORE
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‘SUMMARY COMMENTS:
{ADORESSES STUDENTS CLNCAL COMPETENCE) wath @ S99, desire | to eR best ae
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Me pata SS TS Sy sly, st alt on
sng SS ce ond Sel.Fieldwork Performance Evaluation
For The Occupational Therapy Student
This evalvation isa revision of te 1987 American Occupational Therapy
Assocation, Ine, Fieldwork Evaluation Form for the Occupational
‘Therapist and was produced by a committee of the Commission on
Education
PURPOSE
‘The primary purpose of the Fieldwork Performance Evaluation for the
Occupational Therapy Student is to measure entry-level competence of
the occupational therapy student. The evaluation is designed to tere:
tite the competent student from the incompetent student and is not