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A 0 tn acnsemn OTR Bice, BEN association, inc. Fieldwork Performance Evaluation For The Occupational Therapy Student a. Shayna Kos SIGNATURES: NAME: AST) tr (woot) HAVE READ THIS REPORT. University of Utoh. ‘OLLEGE OR UNIVER Slug. Wika semture dé S100 FIELOWORK SETTING: Anterrrountoun Hedical Center _ Ti OF ORGANZATIONFACILTY ‘NUNEER OF PERSONS CONTRIBUTING TO THS REPORT \a1$.Col street ADDRESS: (STREET OR PO BOX) H ut Aq z ay} _—_—— ae SGAnTURE OF ATEN Lnpotient Neuro Rehob Rachosk Patrick MOT. OTRIL 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 {4O FINAL SCORE vass:_X wo mss: ‘SUMMARY COMMENTS: {ADORESSES STUDENTS CLNCAL COMPETENCE) wath @ S99, desire | to eR best ae full Stora es ard thosaltful har oily 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

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