STUDENT EVALUATION
OF THE FIELDWORK EXPERIENCE
LEVEL IA AND IB
Student Name: ______________________________ Supervisor Name: ____________________
Facility Name: ______________________________ Placement Dates: ____________________
Type of Fieldwork (area): __________________________________________
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Circle
the numerical value that you feel is appropriate for the following fieldwork
placement issues |
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Organization of
the Fieldwork Educational Program
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1.0 |
1.5 |
2.0 |
3.0 |
3.5 |
4.0 |
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Unprepared, expectations
were not discussed |
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|
|
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Facility
was prepared, expectations were clear |
Assignments from
the site
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1.0 |
1.5 |
2.0 |
3.0 |
3.5 |
4.0 |
|
Were
not explained, were overwhelming |
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|
|
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Were
explained, clear, appropriate amount and level difficulty |
Observations of
services or clients
|
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|
1.0 |
1.5 |
2.0 |
3.0 |
3.5 |
4.0 |
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Very little |
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|
|
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All
day every day |
Supervision
|
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1.0 |
1.5 |
2.0 |
3.0 |
3.5 |
4.0 |
|
Supervisor
was rarely available for questions |
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|
|
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Supervisor
was available at all times |
Clinical
Supervisor
|
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|
1.0 |
1.5 |
2.0 |
3.0 |
3.5 |
4.0 |
|
Friendly,
helpful Appeared knowledgeable of services |
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|
|
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Appeared
knowledgeable of services, offered very little explanation |
Professional
relationships
|
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|
1.0 |
1.5 |
2.0 |
3.0 |
3.5 |
4.0 |
|
Student
felt like an outsider, uncomfortable in the setting |
|
|
|
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Student
felt welcomed into the setting |
1 of 2
Comments:
Identify
the strengths of this placement.
Identify
suggestions for improvements to this fieldwork experience.
Identify
any suggestions to the OTA program for preparing a student for this Level I
placement.
Student signature:
__________________________________________________ Date:_____________
Clinical Supervisor
signature_________________________________________ Date: ______________
or
Primary Fieldwork Educator
signature: _________________________________Date: ______________