Student Name WIE MECCA ray ery) — date UNIVERSITY OF UTAH | COLLEGE HEALTH | Divisio of Occu ational Therapy OCCUPATIONAL THERAPY STUDENT PERFORMANCE ASSESSMENT ‘Assessment Competency Exam 112272016 results ofthe interview. Not Observed or | Adequate —] High Level of Competency Components MStitperformed | Skill ‘seit | NIA ib . Thoffectvely. | Demonstrated | Demonstrated 1 Brsparation 2._ Aves at appointment on time i. v 3. Prperes nerve malaria a van 7 4 Establishes appropiate interview environment ie as atviow Administra ee odes eet clent, which indudes acknowledging hents nam, iveducing sol, and sting pupse ofthe | | ftenew in ear undrstandebe language & Estabishes rapport wi cnt ” Z + Bagot and dissses cients pois and oooems fegeting thereon for 2 eferal to ooxpaional theray v 7 Peiomance Goronstalespepaaon end tiariy a with th iteniew format 3am rw core format and ober al pars ctilenven adequse ZL 0 Damoraaes to ait to parapvase end rec ents conten’ and feings v c7Asts alonal open end or caving questions when Glen gives snot or vague responses it FE beto lous cient beck o ntenvionng OHH ee respec manner iF v 73 Uitzes understand Tanquage:Expfas [rgor as L aegoatte A Asie ing Si es Senos appropial ig — Saacjad® Derontates appropat os anqge hin Nin dp ects pve eect peor sce "ASt OF expression, gestures, postural orientation, speaking Fir, volume and ection a v iI TE Demers eeseppropitenierest and every vein response cients behavior Sinwes dowrr 2 S . 77 Reknowodges changes in cnts fect, mood, nd body language. v 7a. Effectively responds to client's affect, mood, and ‘body language 5 Ti Brey saianes cents reaponses ae end of ie ite oI 26. Gies en fl opportunity ask quests a ae Ft fos Gent whale next ses of re itenvenion | process can or wllbe EE on aposTve nol and provides a sense ofosure v Za Cowtnaes et mate efetvely dung inerew wv [ai aes ated ine ocr a a Sain "25, Scotes recorded correctly in form and accurately reflectsD Student Name. ate ‘Overall rating of Student's Assessment Competency Level ‘Skills do not meet shuns mee! (Cire One) campotoncy | Aampetency cz equrements | _fequirements jn To pass this competeacy exam, a student must competently perlrm 20 ofthe 25 interview skils described above | Grading; 46150 s earned if al sk items are marked “adequate ski demonstted". Two pots wil be edded foreach ‘high tovel of ‘Farked: However, the maximum number of points that can be eared fr tis component ofthe OTSPA is 500. Two points wil subtracted for each ski item marked “Not observediPerformed ineffective Comments: Student was ver Cannienhots eeper'ty GY Aspeets ot the Clients occupations aud fe, Tinlee poesoned sty was warm and emuine , Was organized wl preceas , however, m last 3 mr legs CO 8 she med fo 5 9 pack pune Wuseellameus ca peets che trey have wasied (put fdr Too fast ak Frat lout quictely odopies & belew rack. Duet , exelent tulerv0en dazsatn Tame |