THIKA SCHOOL OF MEDICAL AND HEALTH SCIENCES

DEPARTMENT OF HUMAN NUTRITION AND DIETETICS

ASSESSORS ATTACHMENT ASSESSMENT FORM

STUDENT’S NAME……………………………………………………………………..

ADM. NO: …………………………………………………………………………………

PLACE OF ATTACHMENT: ……………………………………………………………

NAME OF ASSESSOR: ………………………………………………………………………..

Use the scale below to evaluate the intern. Check the appropriate response for each of the
following criterion.
5(Excellent) = Performs above the expectations of an Attaché
4 (Very Good) = consistently does well; often exceeds expectations
3 (Good) = Satisfactory; overall acceptable performance
2 (Fair) = Performance adequate some of the time; somewhat inconsistent;
Improvement desired to reach expected
1 (Poor) = Occasionally unacceptable; much improvement needed to meet
Minimum standards
NA (Not applicable) = No rating possible; inadequate opportunity to observe, not able to
Judge, not applicable

CRITERIA 5 4 3 2 1 N/A
I. DECISION MAKING AND PROBLEM SOLVING
Able to assimilate appropriate information as part of problem solving and
decision making. Asks appropriate questions that demonstrate critical
thinking. Uses sound judgment in planning food and nutrition services.

II. WILLINGNESS AND INTEREST IN LEARNING

Demonstrates a genuine interest and enthusiasm for the practice of
dietetics. Accepts assignments and responsibility willingly. Demonstrates
self-motivation in the completion of projects and assignments

III. ORGANIZATION AND PLANNING SKILLS

Uses time productively and efficiently. Demonstrates the ability to be
flexible and adaptable. Follows through on assigned duties and tasks.
Able to plan and implement an in-service or special project well.
Demonstrates independence in the completion of projects and
assignments.

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IV. PROFESSIONAL BEHAVIORS (dress, attendance, ethics, and
confidentiality)
Appears neat and professional. Reports to work in a timely manner.
Respects the rights and confidentiality of patients, employees and peers.
Respects the time constraints and the job responsibilities of the preceptor.
Meets standards of professional practice & professional code of ethics.

V. PROFESSIONAL AND PERSONAL DEVELOPMENT

Demonstrates ability to accept corrective feedback and suggestions for
improvement. Accepts responsibility and consequences for own actions
and decisions. Identifies areas of personal strengths, weakness and goals

VI. INTERPERSONAL & COMMUNICATION SKILLS

Interacts positively with peers and staff. Demonstrates the ability to work
well with both individuals and groups. Uses appropriate language when
communicating with professionals, clients, and the public. Listens
carefully to diverse points of view. Is patient & tolerant of others.

VII. PARTICIPATES APPROPRIATELY WITH HEALTH CARE

PROFESSIONALS.
Respects and understands the role of other team members. Confers &
collaborates with appropriate health care providers to assist in
implementing interventions.

VIII. DEMONSTRATES APPROPRIATE KNOWLEDGE OF

NORMAL AND THERAPEUTIC NUTRITION PRINCIPLES AND
INFORMATION
Understands and uses medical terminology, abbreviations, laboratory
results, etc. correctly.
Understands pathophysiology of disease states & rationale of dietary
modifications. Incorporates new scientific knowledge into practice.

IX. SCREENS AND ASSESSES PATIENTS ACCURATELY

Obtains nutritionally relevant data from the medical record and patient
interview. Evaluates both objective and subjective data to identify
nutrition problems and needs. Performs accurate calculations needed for
nutrition assessment.

X. DEVELOPS AND IMPLEMENTS APPROPRIATE NUTRITION

CARE PLANS
Identifies expected outcomes/goals that relate to nutrition problems.
Determines appropriate interventions. Communicates plan to appropriate
persons. Verifies that care is implemented. Evaluates the effectiveness of
nutrition interventions.

XI. DOCUMENTS NUTRITION CARE APPROPRIATELY

Maintains current and updated information in patient’s medical record and
department records. Writes in a neat, clear and concise manner
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XII. PROVIDES APPROPRIATE NUTRITION EDUCATION TO
PATIENTS, FAMILY & OTHER PROFESSIONALS
Assesses educational needs and readiness for learning. Uses strategies that
meet these needs. Communicates verbally in a clear, understandable
manner. Advocates the importance of nutrition in health promotion and
disease treatment. (May also use evaluation tool for education.)

XIII. PREPARATION FOR EDUCATION SESSION OR

PRESENTATION
Conducts appropriate needs assessment and gathers assessment data (diet
and health history, etc.). Assembles education materials and resources.
Prepares physical environment that supports learning and minimizes
distractions.

XIV. AUDIO VISUAL MATERIALS AND HANDOUTS

Develops and/or selects materials that are easily understood and relevant
to subject. Evaluates appropriate education material to client level of
understanding. Uses easily seen visuals that enhance presentation.

XV. RAPPORT WITH CLIENTS/AUDIENCE

Introduces self and others as appropriate. Makes those present feel at ease.
Captures and maintains attention of those present. Encourages client &
audience participation including questions. Respects cultural, social and
economic diversity

XVI. COMMUNICATION STYLE & TECHNIQUE

Uses positive non-verbal communication (facial expression, eye contact
and body language). Uses a positive voice tone and presents material with
enthusiasm and interest. Varies voice inflection. Speaks clearly with
appropriate voice volume and speed. Uses terms and language that
clients/audience can understand. Gives clients opportunity to make
comments. Does not interrupt. Listens well. Maintains control. Is
“assertive” but avoids “lecturing”. Individual counseling and small
groups:
Uses primarily open-ended questions. Tolerates periods of silence.

XVII. CONTENT
Presents information that is accurate and well organized. Incorporates
current scientific information into education. Explains purpose and
objectives clearly. Summarizes key concepts and important content.
Responds to questions accurately & appropriately

Comment:

Date: ……………………………. Sign: ……………………………….. Stamp:…………………………….

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