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Clinical Facility: WHEATON

Date: 12/12/14

Student: MARISA DIEHL

FRANCISCAN

Gateway Technical College


Surgical Technology Program

Clinical Evaluation
512-133 Clinical II
Scoring for Clinical Evaluation
4 = Excellent
3 = Good
2 = Acceptable

(C~~

3.5 = Very Good


2.5 = Average
0= Unacceptable [Below 2]

Professional
Characteristics
~
Competency
A. Accept Responsibility
Experiences.

Comments

for Own

4 3.5 3

2.5

~ 3.5 3

2.5

2.5

/
1. Adheres to dress code

o Absences
2. Demonstrates Dependability

3.5 3

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