Individual Evaluation Printed: 11/16/2018

Subject: Hayley Robinson

Activity/Site: Level One FW 6389 School at Specialized Speech Technologies
Time Frame/Partic: Level I Schools 2018 (10/10/2018 to 12/5/2018) / (10/10/2018 - 12/05/2018)
Evaluation Type: Fieldwork Level I Evaluation
Evaluator: Shardae Burks

001.0 STUDENT NAME

Hayley Robinson

001.0 Number of Hours Completed:

51.5

001.0 FACILITY SUPERVISOR- NAME and CREDENTIALS/TITLE:

Shardae Burks, MOT, OTR/L

001.0 Years of Experience:

3 years 9 months

001.0 Supervisor Email Address (for CEU certificate)

shardae@specializedspeech.com

001.0 FACILITY NAME:

Specialized Speech Technologies Inc.

002.0 1. Dependability (consider ability to arrive on time, follows through on assignments, notifies supervisor of
schedule issues)

1
2
X 3

002.0 2. Competence (consider ability to be prepared, asks for help when needed, ensures safety, comfort, and
rights of clients)

1
X 2
3

Hayley Robinson Level One FW 6389 School at Specialized Speech Technologies Page 1
002.0 3. Communication (consider ability to use appropriate level of language, positive non-verbal communication
and tone, maintain boundaries, responds well to and uses feedback)

1
X 2
3

002.0 4. Integrity (consider ability to respect and maintain confidentiality, act with honesty, accept responsibility for
self, value and care for the equipment and resources of the facility)

1
X 2
3

002.0 5. Cooperation and Teamwork (consider ability to make positive contributions to the team process, accept
group decisions, complete own share of the work, give credit to those who deserve it)

1
X 2
3

002.0 6. Empathy/Compassion (consider ability to be non-judgmental and respectful, culturally sensitive, and listen
actively)

1
2
X 3

002.0 7. Initiative/Self-directed learning (consider ability to be motivated, to seek out opportunities to acquire
information from a variety of sources, and accept and apply feedback)

1
X 2
3

002.0 8. Professional Appearance (consider appropriate clothing, good personal hygiene, discrete body adornment,
appropriate body posture and facial expressions that send reassuring messages to clients)

1
X 2
3

002.0 9. Flexibility/Adaptability (consider ability to make change to treatment plan, react to client, make change in
self after feedback)

1
X 2
3

Hayley Robinson Level One FW 6389 School at Specialized Speech Technologies Page 2
002.0 10. Assessment Activities (consider choosing correct assessment, adheres to standardization, correctly
documents results)

1
X 2
3

002.0 11. Intervention Activities (consider matching intervention to assessment and client needs, executes activity
without assistance)

1
X 2
3

002.0 Overall Score: Please rate your overall impression of this student's performance
*In order to pass, needs to obtain an M in this category*

1
X 2
3

003.0 Comments

Hayley was a wonderful student to have! She was a hands on learner and she jumped right in from the start. Hayley asked
questions and accepted and allied feedback well. She showed up on time weekly and was eager to learn and help in anyway
needed.

004.0 Supervisor Electronic Signature:

Please enter your name in the text box below-

Shardae Burks

005.0 Date:

11/12/2018

Hayley Robinson Level One FW 6389 School at Specialized Speech Technologies Page 3