w •

UNIVERSITY OF UTAH
COLLEGE oF HEALTH
I
Division of Occupational Therapy
FIELDWORK I OBSERVATION OF STUDENT PERFORMANCE

Student's Name: Derek Jones Fieldwork Facility: Stonehenge of South Jordan

Supervisor's Name: Emily Cahoon Dates of FW: 3/5/18 -3/16/18
r ,va~v VI IV\,," I.I IV 111v,,.;n Ut,..lt,JI VtJI ,u,.... I Ul.11 •M•

Professional Behavior Needs Not

Outstanding Adequate Improvement Observed
The student:
1. Conforms to institution's dress code . X
2. Is responsible and dependable in attendance and promptness. X
3. Communicates effectively with other professionals/staff. Listens and speaks at X
appropriate times.
4. Contributes toward open communication with supervisor. Gives and receives feedback X
aooropriately.
5. Establishes and maintains therapeutic relationships with clients and their families. X
6. Demonstrates professional values and ethics. X
7. Maintains the confidentiality of others. X
8. Seeks information and asks relevant questions. X
Uses resources and time effectively.
9. Follows through with suggestions made by supervisor. X
10. Seeks challenges and demonstrates enthusiasm for fieldwork experiences. X
11 . Demonstrates independence when appropriate. X
12. Flexible: effectively adjusts to changes; adjusts priorities without difficulty. X
Related to Educational Objectives Needs Not
The student has: Outstanding Adequate Improvement Observed
13. Developed an increased comfort level interacting with persons who have disabilities, X
emotional problems, or psychiatric disorders.
14. Described the needs of clients served by the agency/facility. X
15. Demonstrated respect for the values and diversity of persons with disabilities, X
careqivers, staff and volunteers.
16. Demonstrated an attitude of inquiry to enhance creativity and problem solving skills. X
17. Observed staff interactions, assessments and/or treatment sessions with agency/facility X
clients.
18. Participated in group or individual treatment sessions as appropriate depending on the X
skill level of the student and the severitv of the client's disability/illness.
19. Observed OTR/COTA role delineation when Certified Occupational Therapy Assistants X
are employed by the agency/facility.

Strengths of the student noted at this fieldwork:

 ii; •
UNIVERSITY OF UTAH
COLLEGE oF HEALTH I Division of Occupational Therapy

Student's Name:
Supervisor's Name:
..
1) 6/l ~

-- ______ ---- ··--- ..

, ·------ .-- - - -
JON~S
C/1-1'1 P A/U'IJJ'F:Y , l"tS,

.
FIELDWORK I OBSERVATION OF STUDENT PERFORMANCE

f
- · · • ~-:,,•
I
~r,t..fc.
Fieldwork Facilfy:
Dates of FW: C,/;
I
rv';Jfl
'7 17 - C. z..7 , '?
T?>-L a ,::- L[T)tf/
)

Professional Behavior Needs Not

The student: Outstanding Adequate Improvement Observed
1. Conforms to institution's dress code.
2. Is responsible and dependable in attendance and promptness.
r-
~
3. Communicates effectively with other professionals/staff. Listens and speaks at
aooropriate times. ~
4. Contributes toward open communication with supervisor. Gives and receives feedback
.t ,
aooropriately.
5. Establishes and maintains therapeutic relationships with clients and their families. p<
6 . Demonstrates professional values and ethics. kl
7 . Maintains the confidentiality of others. >4
8. Seeks information and asks relevant questions. 17'---
Uses resources and time effectively.
9. Follows through with suggestions made by supervisor. ~
10. Seeks challenges and demonstrates enthusiasm for fieldwork experiences. ~
11 . Demonstrates independence when appropriate. 'x\.
12. Flexible: effectively adjusts to changes; adjusts priorities without difficulty. X
Related to Educational Objectives Needs Not
The student has: Outstanding Adequate Improvement Observed
13. Developed an increased comfort level interacting with persons who have disabilities,
;(
emotional problems, or psychiatric disorders.
14. Described the needs of clients served by the agency/facility. ,<!_
15. Demonstrated respect for the values and diversity of persons with disabilities,
caregivers, staff and volunteers. K
16. Demonstrated an attitude of inquiry to enhance creativity and problem solving skills. ,.L!...
17. Observed staff interactions, assessments and/or treatment sessions with agency/facility
clients. P'--
18. Participated in group or individual treatment sessions as appropriate depending on the
skill level of the student and the severity of the client's disability/illness.
Jr-
19. Observed OTR/COTA role delineation when Certified Occupational Therapy Assistants ~
are employed by the agency/facility.
.----,-,

UNIVERSITY OF UTAH
DIVISION OF OCCUPATIONAL THERAPY
FIELDWORK I OBSERVATION OF STUDENT PERFORMANCE

Student's Name: ~q,;- \::._ -Jca'l£ 5 Fieldwork Center: (~...~1'.\ $ ,1...- k t~ ~ l,c t '·, ~

S upe rv .Is ors

' N . ,.--,
ame. ,:,r " ' u _ -~-.., .L l....:-1....· _..,_I.--_ _ __ _ __ Dates of FW: ;,(_ /4(, - ½ Ii'-/
Please check the most appropriate rating :

g'
c., .,
-0

Professional Behavior -0 ~ E
...,
.,
C:
C
"'::;,-
:, "'
.J:J
The student: "'
;;; ., "' 0> 0
"5
0
-0
<
:
-0
~ -
z E. 0
z
. 1. Conforms to inst itution's dress code. . ···- - -·-- . . .. - -- -
v
·- - - --- . - -- - - -- - - -- - -- -
,,v -
' 2. Is resp_o_!lsible and depe~ ~C3~J_e in attendance and p~~mptness. ..,,., ___
- ·--··-· ------·- · -·-• --·
· 3. lnitlates and com.p_ ~etes all assignments promptly_._____ __ v ~ ·- •- - · 1•-P _..,
' 4. Communicates effectively with other professionals/staff. Listens and speaks at
appropriate times. __ _ _ _ _______ _ _ __ _____ _ / ;
i 5. Contributes toward open communication with supervisor. Gives and receives feedback
/
~--- ~pr~riately. _ ___ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ _____ ___ ___ ________
, ____ :_________,
:_§_. _ Establishes and maintai~~J~E:!:apeutic relationshj ~~--\Y.!~.b..~l~~'!l ~-~r::!~ ! ~~ i~~~_l!ll~es:___ __ : ~---- ·________ :
1 7. Presents reports in a cl~_a_r:_&__pr~fessional ma~(!~!:________________________ _ __ _ _ _ _ __ ___ £ _____ J __._.______ _;
J?..: _ g_~r:i_i(?_~~_!_r-~tes .P.~ fessJo_n_al valu~.?-~ ~ ethics. ____ _______ --- '. _____ L __J
'-~~ -- ~-:1al~~ins the conf~denti~[ty _ oth_ ot ~ r-~_. _ _ _____________ _ ... __ _____ _________ _ __\_______ ; _/_ _L ___ __________ _
l 10 . Seeks j~formation an_Q_ as_ks_I~levant gu~~tions . Uses res~urces and ti ~t?,_e,!~e~tjl{_e_lY...:. _ _ _ __ ,L___ , . ___
j 11. Follows thrwgj)With suggestions made by supervisor. _ _____ __ . _____ _________ ✓ i _____ J_ L __ __
! __ _____ ;
I 12. S~~-~~challenges and de_!!_lg!!strates ~ nthusiasrn for fieldwork experi~-~~~s.: ... _____ _____ / __ L _7"·-L-____~---__ _
\ 13:___Q~~<?_nstrates indepe12_d_ence when ap£ropriate . ____ __ __ _ ____ ______ ·- ________ ! _ ! L::__ 1

; 14 . Flexible: effectively adjusts to changes: adjusts priorities without difficulty. 1 Y

 De~ h ; ~ ~C- iv IJJuf~ wiJh ~ frut Z wP~S ft ~ r-Q;i-bf_c~
3r~~ dt:?11~f entnlhslas:!vi 1hj°✓e5t o..ncl e~-h-se tJJhile ~v~1\1~Yf1 ~ \'Wi1-~~ 1wrW']
S~vd.err s , n -+he educoitorwJ J,Uhtt~ •
1
~ ..JI

Areas the student could work toward inpro¥ng cuing rL■IQ fieUwndc ~wiw•-
c()L,i; •tL-e \vi#} !ear11.i rt1 +- 5rilii~..:;,
Additionai comments:

l)r~ bVas very ~ve. o.rrJ jb--liuf lltl1le ~fJtr~ lf/M-i ~ cJiadren •.-hL~
o.,n d a Vari et'( of e#t~ -ht'" ~11~M.
J>f- 1w ~ IL plulif~ -/.o 'Jo,'lc wtH,, lxfek. #-e \\A,, ntake Q --fraJtV1dW {
tlise-f- 'lo o.Y ~~; on !
~~
~:=? - :futifum ~
s.,p,r.....- SV- . ~/4
I ~ ., -.
--.., ,K. t i . ~ ?:'Jt:.·-.·

?tease give to the student to retun, or mail to:

Jeanette Koski, OTR/l

Academic Fieldwork Coorcinator
Division of Occupational Therapy #

University of Utah
520 Wakara Way
Salt Lake City. UT 84108-1290
 w
•
UNIVERSITY Of UTAH
COLLEGE oF HEALTH
.,
Division of Occupational Therapy
FIELDWORK I OBSERVATION OF STUDENT PERFORMANCE
Student's Name: 1£reJ<. ~o Y\ e 5 Fieldwork Facility: ~ ,·-k:, J:e-h OD I D,d-t c;f
Supervisor's Name: f£ifher- tJeJion DatesofFW: _ _ _ _ _ _ _ __

• ·- -- --■--- - · - - -- · ··--- ...........

· 1te rat'
, ..... -- - -"'M •
Needs Not
Professional Behavior
Outstanding Adequate Improvement Observed
The student:
1. Conforms to institution's dress code. - ✓
2. Is responsible and dependable in attendance and promptness. v
✓
3. Communicates effectively with other professionals/staff. Listens and speaks at
aoorooriate times.
4. Contributes toward open communication with supervisor. Gives and receives feedback
approoriatelv. \/
5. Establishes and maintains therapeutic relationships with clients and their families. ✓
6. Demonstrates professional values and ethics. v7
7. Maintains the confidentiality of others. ~
8. Seeks information and asks relevant questions.
Uses resources and time effectively. ✓
9. Follows through with suggestions made by supervisor. v
10. Seeks challenges and demonstrates enthusiasm for fieldwork experiences. ✓
11. Demonstrates independence when appropriate. -../,,,.
12. Flexible: effectively adjusts to changes; adjusts priorities without difficulty. ✓
Related to Educational Objectives Needs Not
The student has: Outstanding Adequate Improvement Observed
13. Developed an increased comfort level interacting with persons who have disabilities,
emotional oroblems, or psychiatric disorders. ✓
14. Described the needs of clients served by the agency/facility. v
15. Demonstrated respect for the values and diversity of persons with disabilities,
careaivers, staff and volunteers. ✓
16. Demonstrated an attitude of inquiry to enhance creativity and problem solving skills.
17. Observed staff interactions, assessments and/or treatment sessions with agency/facility
v
clients. ✓
18. Participated in group or individual treatment sessions as appropriate depending on the
skill level of the student and the severitv of the client's disabilitv/illness. ✓
19. Observed OTR/COTA role delineation when Certified Occupational Therapy Assistants
are employed by the aaency/facilitv. ✓
 ~A® The American
An
- -
, 11, Occupational Therapy
- - Association, Inc.

Fieldwork Performance Evaluation

For The Occupational Therapy Student

MSJMR. ]c,.JG.S _Q:~/(, SIGNATURES:

NAME: (LAST) (FIRST) (MIDDLE) I HAVE READ THIS REPORT.
LJ,-.y: V6f.SI:-D o~ Ulrfrt+
COLLEGE OR UNIVERSITY ~2~~-
SIGNATURE OF STUDENT

FIELDWORK SETTING:
V1: tfrnPLT'f&, Sl)-L-1 llt-'f-.6 CI))
NAME OF ORGANIZATION/FACILITY NUMBER OF PERSONS CONTRIBUTING TO THIS REPORT

$"C() ~ , H-~u_ ~tc,v(S

ADDRESS: (STREET OR PO BOX)

Sit-Li- L1t-;:.e;
CITY
c:tn UiA-tt
STATE
gy14s
ZIP
~~
SIGNATURE OF RATER #1

P~s OvJ (r€NYLT1:er:JFK') [T) &dC ~eL-L-_ o, t_/L

TYPEO FIELDWORK PRINT NAME/CREDENTIALS/POSITION

ORDER OF PLACEMENT: (D 2 3 4 OUT OF 1 <f) 3 4 ·

FROM: s-L1<-/) &6/t TO: ~ / /0 / 8-dlE

DATES OF PLACEMENT SIGNATURE OF RATER #2 (IF APPLICABLE)

5"8-0
NUMBER OF HOURS COMPLETED PRINT NAME/CREDENTIALS/POSITION

/J.9
FINAL SCORE

PASS: / NO PASS: _ _ _ __

SUMMARY COMMENTS:
(ADDRESSES STUDENT'S CLINICAL COMPETENCE)

~ 1-½s B~ 4 CJM1 STLO&-r,/ He lfls D~c!J ~

~,~J:r~ ~ 01 A-.J{) .I:T?:. AQp~-~ ~ -~ ~
rrosP-2-i'fK.- S&r~, ~~~uWJ>t J:.J ~ rc..u. ~ ~ Sftw,j
G.(~D d..I:~ TH-J::-5K.J;JG_ Ar--0 AP()l.Ufh-~ ~ OT To Trk,
Vef13 ~ ~ ~ A - ~ - - - ~ . b<L6!\ LAC-LL C0rI;:t..uU~IQ
I

~ o.,J ~ S0J::.c~ ~ it:.u _ fl~ Ir GL~--- 61 !

 RATING SCALE FOR STUDENT PERFORMANCE II. BASIC TENETS: -
4 - Exceeds Standards: Performance is highly skilled and self-initiated. 4. Clearly and confidently articulates the values and beliefs of the
This rating is rarely given and would represent the top 5% of all the occupational therapy profession to clients, families, significant oth·
students you have supervised. ers, colleagues, service providers, and the public.
3 - Meets Standards: Performance Is consistent with entry-level practice. Midterm 1 2 (D 4
This rating is Infrequently given at midterm and Is a strong rating at
final. Final 1 2 6) 4
2 - Needs Improvement: Performance Is progressing but still needs 5. Clearly, confidently, and accurately articulates the value of occu-
improvement for entry-level practice. This is a reallstlc rating of
pation as a method and desired outcome of occupational therapy
performance at midterm, and some ratings of 2 may be reasonable at
the final. to clients, families, significant others, colleagues, service providers,
and the public.
1 - Unsatisfactory: Performance is below standards and requires
development for entry-level practice. This rating is given when there Is Midterm (VJ 3 4
a concern about performance.
Final 2 (D 4
6. Clearly, confidently, and accurately communicates the roles of
the occupational therapist and occupational therapy assistant
I. FUNDAMENTALS OF PRACTICE: to clients, families, significant others, colleagues, service providers,
All items in this area must be scored at a #3 or above on the final and the public.
evaluation in order to pass fieldwork. (y
Midterm 3 4
1. Adheres to ethics: Adheres consistently to the American G)
Final 2 4
Occupational Therapy Association Code of Ethics (4) and site's
policies and procedures including when relevant, those related to 7. Collaborates with client, family, and significant others throughout
human subject research. the occupational therapy process.
Midterm 2 CP 4 Midterm G) 3 4
Final 2 (f) 4 Final 2 © 4
2. Adheres to safety regulations: Adheres consistently to safety Comments on strengths and areas for improvement:
regulations. Anticipates potentially hazardous situations and takes • Midterm
steps to prevent accidents.
Midterm 2 6)) 4
• ~ @~..:It) &1ce c>-~ ~ Mn_
Final 2 © 4 ?ee>\li.D&.S \. •'-
,· -~
3. Uses judgment in safety: Uses sound judgment in regard to safe- '- . " .... .•' \.

ty of self and others during all fieldwork-related activities. •P~ei~ c,t.M- ~ Cq.l~G- J:J·~
Midterm 2 ~ 4 1b ~ It S:<St...vJ:c<::.
Final 2
D 4
Comments on strengths and areas for improvement:
• Midterm

• Flnal
1c,L6{:il_,y eex.&
~TJ:CLJLft~ -
-6 ~ d 1 Th P1tw:&r7$. A-Nll t ~

• Final , COu. ~Bd,.,.~ ~ ~ - ' ~'t ~

- 6CC{) +tr-t--te-Ak:{S iO S-4fcTy ?1'-T~'11. A-,-so ~ 1o ~ -
~'$.
~c~~ cc>~ P ~ ~.LXJN'fr<--S
AS i-St:-Ll.. A:,r P11-,::ce-r-J·-rr.
 15. Interprets evaluation results to determine client's occupational
RATING SCALE FOR STUDENT PERFORMANCE performance strengths and challenges.
4 - Exceeds Standards: Performance is highly skilled and self-initiated.
This rating is rarely given and would represent the top 5% of all the
Midterm 1 (g) 3 4
students you have supervised.
3 - Meets Standards: Performance is consistent with entry-level practice.
Final 2 0 4
16. Establishes an accurate and appropriate plan based on the
This rating is infrequently g!ven at midterm and is a strong rating at
evaluation results, through integrating multiple factors such as
final.
client's priorities, context(s), theories, and evidence-based practice.
2 - Needs Improvement: Performance is progressing but still needs
improvement for entry-level practice. This is a reallstlc rating of Midterm 1 ~ 3 4
performance at midterm, and some ratings of 2 may be reasonable at
the final. Final 1 2 @ 4
1- Unsatisfactory: Performance is below standards and requires 17. Documents the results of the .evaluation process that demon-
development for entry-level practice. This rating is given when there is strates objective measurement of client's occupational perform-
a concern about performance. ance.
Midterm 2 CD 4
Final 2 3 ~
111. EVALUATION AND SCREENING:
Comments on strengths and areas for improvement:
8. Articulates a clear and logical rationale for the evaluation
• Midterm
process.
o CCflf(.6-TG ~ -:LJ&ii-- ~ ~
Midterm ~ 3 4
CN ,ts~M &-r-JT ~ u '--~
Final 2 6) 4
9. Selects relevant screening and assessment methods while
considering such factors as client's priorities, context(s), theories,
and evidence-based practice.
Mid1erm 1 (!j) 3 4
Final 1 2 {[Y 4
10. Determines client's occupational profile and performance
through appropriate assessment methods.
Mid1erm 1 2 ·@.·· )
4__. ,,., • Final

Final 1 2 6) 4 • 0-&Af..L ~tlef.Dl~ NI~ ~ mt

11 . Assesses client factors and context(s) that support or hinder
occupational performance.
er-ks~ fYI~ ee, ('10,JsrfJff~ G<ti)
Midterm 1 W 3 4
.t&:u...,y ~ d.6A-~ ~l.fr,.J of C/}4;
Final 2 a, 4 - 6XC1e-u..&rJ1 lJ()CU'Y) ~Mi~ I I

12. Obtains sufficient and necessary information from relevant

resources such as client, families, significant others, service
providers, and records prior to and during the evaluation process.
Mid1erm 1 @ 3 4
1 1 1
Final ~- 2@ '4
13. Administers assessm~nts 1n·a u~ifo;m·manne~to e;sure findings
IV. INTERVENTION:
are valid and reliable. 18. Articulates a clear and logical rationale for the intervention
' , \, ; "T l .• 'l .,,t,

Midterm 1 © 3 -1 process.

~
1
Midterm _ 3 4
Final 1 2 (]) 4
14. Adjusts/modifies the assessment procedures based on client's
Final ~ ' - '1 2 a> 4
needs, behaviors, and culture. 19. Utilizes evidence from published research and relevant resources
Midterm 1 @ to make informed intervention decisions.
3 4
Midterm 1. G)> 3 4
Final 2 © 4
Final 2 @ 4
20. Chooses occupations that motivate and challenge clients. V. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES:
Midterm 1 © 3 4 27. Demonstrates through practice or discussion the ability to
assign appropriate responsibilities to the occupational therapy
Final 1 2 (D 4 assistant and occupational therapy aide.
21 . Selects relevant occupations to facilitate clients meeting estab-
Midterm 1 <'.[) 3 4
lished goals.
{]J) 3 4
Final 1 2 @ 4
Midterm
28. Demonstrates through practice or discussion the ability to
Final 2 @ 4
actively collaborate with the occupational therapy assistant.
22. Implements intervention plans that are client-centered.
Midterm 1 (g) 3 4
Midterm 1 © 3 4
Final 1 2 6) 4
Final 1 2 (:i> 4
29. Demonstrates understanding of the costs and funding related
23. Implements intervention plans that are occupation-based. to occupational therapy services at this site.
Midterm 1 2 Q) 4 Midterm 1 . (2) 3 4
Final 1 2 3 u) Final 2 ~ 4
24. Modifies task approach, occupations, and the environment to 30. Accomplishes organizational goals by establishing priorities,
maximize client performance. developing strategies, and meeting deadlines.
Midterm . 1 6) 3 4 Midterm 1 2 @ 4
Final 2 ® 4 Final 1 2 © 4
25. Updates, modifies, or terminates the intervention plan based 31 . Produces the volume of work required in the expected time
upon careful monitoring of the client's status. frame.
Midterm 1 &) 3 4 Midterm @> 3 4
Final 2 CD 4 Final 2 <© 4
26. Documents client's response to services in a manner that Comments on strengths and areas for Improvement:
demonstrates the efficacy of interventions.
• Midterm
Midterm 1 2 @ · 4
•C6Lc..."4&dL4-TE, ())cf..6 C, ~
Final 1 2 3 ©
Comments on strengths and areas for improvement:
~ o PAi-:i]SrlT ~
• Midterm

• -.Jrte,,y ~ ;:ie.J.4-<.-- Ac.:~ v ~/

cx~e:s K) f"1a,:u11r~ p,-

• Final

I D~~ ~ I-~ T:t!"l~y .r,-J

Ge-,,~ 1Jo_j& m /).~

;--b~
I ' •
• Final
As' mMoo.t:rSl'.i Cil=sE;-lOAP f!PP~f.JJMc.."{_,r.
~ t xc c cc. 5-J1 uJ~ o~ ocu..,i(.)1-~ s<. \"'1 ' \ t'..

M-- ~ c u ~ Pct.~s~ I l)6,l'\0,JS.7'«1n""M :J:fal.f~6'J A f j ~ ~

, & ~ ~ Do~~ffi-~ of I P, AMO Ca<.<.. ~Ol.tr-r~ c THt:: e;·lrr

~ f6 ~1S K) ~

~"'- r.---..,,-~
;:,:,. - :::.::w;_ 2

."ii_
~~,_.,,,.---. 4#-- w
¥~ 4 --

----~-- =-=- -
 PERFORMANCE RATING SUMMARY SHEET

Performance Items Midterm Ratings Final Ratings

I. FUNDAMENTALS OF PRACTICE
1. Adheres to ethics .! J
2. Adheres to safety regulations s .:s
3. Uses judgment in safety - ~ .J
- ~

11. BASIC TENETS OF OCCUPATIONAL THERAPY

4. Articulates values and beliefs
5. Articulates value of occupation
s 3
ff. s
6. Communicates role of occupational therapist ol 3'
7. Collaborates with clients a.. 3 -
111. EVALUATION AND SCREENING
- --- --
8. Articulates clear rationale for evaluation a .s
9. Selects relevant methods A 'l
1O. Determines occupational profile :s l
11. Assesses client and contextual factors ol s
12. Obtains sufficient and necessary information a. J
13. Administers assessments 0,. .3
14. Adjusts/modifies assessment procedures a.. 3
15. Interprets evaluation results a 3
16. Establishes accurate plan oL .3
17. Documents results of evaluation j lf
IV. INTERVENTION - - - -·
- - ~- - -- -
18. Articulates clear rationale for intervention ex J
19. Utilizes evidence to make informed decisions a 3
20. Chooses occupations that motivate and challencie 3
21 . Selects relevant occupations
.0.
'
&. 5
22. Implements client-centered interventions d-. .s
23. Implements occupation based interventions d <-/
24. Modifies aooroach, occupation, and environment 3-- 3
25. Updates, modifies, or terminates intervention plan A J
26. Documents client's response -
~ . 'i
V. MANAGEMENT OF OT SERVICES - - - - - - -
27. Demonstrates ability to assign through practice or discussion a. ,S
28. Demonstrates ability to collaborate through practice or discussion a s
29. Understands costs and funding ~ J
30. Accomplishes organizational goals J s
31 . Produces work in expected time frame & 1
- -
VI. COMMUNICATION - .. --- ---- I

32. Communicates verbally and nonverbally «. 3

33. Produces clear documentation 3 J
34. Written communication is leoible s J
35. Uses language appropriate to recipient
-- s -- 3
VII. PROFESSIONAL BEHAVIORS - - -
-
,. _____ -

:s - - -
- --- ~- -- -- -
36. Collaborates with supervisor - 3
37. Takes responsibility for professional competence 3 J
.
38. Responds constructively to feedback -s .s
39. Demonstrates consistent work behaviors 3 :r
40. Demonstrates time manaqement 3' -1
41 . Demonstrates positive interpersonal skills' ~ .s
42. Demonstrates resoect for diversity 3 3
TOTAL SCORE u :, ;i A /B9

MIDTERM: FINAL:
_Satisfactory Performance . ..... . . . ..... 90 and above Pass . .. . .. . ... . ...... ... .. .. ... . . 122 points and above
Unsatisfactory Performance ..... ... .. . . 89 and below No Pass ........... .. . ... . . ..... . . 121 points and below
 RATING SCALE FOR STUDENT PEAt-UHIVIAl'Jl;t.
4 - Exceeds Standards: Performance is highly skilled and self-initiated. 36. Collaborates with supervisor(s) to maximize the learning
This rating is rarely given and would represent the top 5% of all the experience.
students you have supervised. Midterm 2 4
3 - Meets Standards: Performance is consistent wtth entry-level practice.
This rating is infrequently given at midterm and is a strong rating at Final 2 4
final. 37. Takes responsibility for attaining professional competence by
2 - Needs Improvement: Performance is progressing but still needs seeking out learning opportunities and interactions with supervi-
improvement for entry-level practice. This is a realistic rating of sor(s) and others.
performance at mldtenn, and some ratings of 2 may be reasonable at
the final. Midterm 2 @ 4
1 - Unsatisfactory: Performance is below standards and requires
development for entry-level practice. This rating is given when there is
Final 2 ® 4
a concern about perfonnance. 38. Responds constructively to feedback.
Midterm 2 0 4

VI. COMMUNICATION: Final 2 ® 4

32. Clearly and effectively communicates verbally and nonverbal- 39. Demonstrates consistent work behaviors including initiative,
ly with clients, families, significant others, colleagues, service preparedness, dependability, and work site maintenance.
providers, and the public. Midterm 2 @' 4
Midterm 3 4 Final 2 © 4
Final 2 ® 4 40. Demonstrates effective time management.
33. Produces clear and accurate documentation according to site Midterm 2 d) 4
requirements.
Midterm 2 4
Final 2 CD 4
41. Demonstrates positive interpersonal skills including but not lim-
Final 2 4 ited to cooperation, flexibility, tact, and empathy.
34. All written communication is legible, using proper spelling,
punctuation, and grammar.
Midterm 1 2 © 4

Midterm 2 d) ~
Final 2 © 4
42. Demonstrates respect for diversity factors of others including
Final 2 ([) 4
but not limited to socio-cultural, socioeconomic, spiritual, and
35. Uses language appropriate to the recipient of the information, lifestyle choices.
i~cluding but not limited to funding agencies and regulatory agen- Midterm 2 4
cies.
Final 2 4
Midterm 2 4
Comments on strengths and areas for improvement:
Final 2 4
• Midterm
Comments on strengths and areas for improvement:
• Midterm

• Final • Final
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