MEDICAL LABORATORY SCIENCE INTERNSHIP PROGRAM

HOSPITAL AFFILIATION EVALUATION SHEET

HOSPITAL/MEDICAL CENTER: _____________________________________________________________

INCLUSIVE DATE OF INTERNSHIP: __________________________________________________________

Direction: Check your answer in the appropriate box.

Excellent Above Average Below Not at

Average Average All
A. Physical Set Up 5 4 3 2 1

1. Modern clinical laboratory instruments

2. Provide specific laboratory section

3. Employ standard evaluating procedures

4. Provision of locker, cabinet and intern’s lounge

5. Maintain quality assurance, quality control program
and periodical calibration of instruments and reagents
6. Provides biological safety cabinets, first aid kits and
fume hood for toxic chemicals.

B. Learning Experience

1. Employ standard operating procedures (SOP)

2. Interns are allowed to handle machines or laboratory
instruments independently

3. Conduct seminars, workshops and colloquium

4. Center is suitable for academic growth with theoretical
supplements

TOTAL: ____________________

COLLEGE OF MEDICAL LABORATORY SCIENCE / OUR LADY OF FATIMA UNIVERSITY