SAINT LOUIS UNIVERSITY

SCHOOL OF NATURAL SCIENCES

DEPARTMENT OF PHARMACY
PERFORMANCE EVALUATION REPORT
FOR

INDUSTRIAL

PHARMACY STUDENT TRAINEE

NAME OF STUDENT : ____________________________________________________________________________________________

NAME AND ADDRESS OF ESTABLISHMENT : ______________________________________________________________________
______________________________________________________________________
DATE STARTED : ___________________________
DATE ENDED: ______________________________

EVALUATION PARAMETERS

RATING SCALE

I. JOB KNOWLEDGE
A. Background Information/organization/

Facilities/ policies/ laws/ references

1. Organizational Set-up
2. Facilities
3. Company Policies
4. Laws, Regulations and Other Pharmacy References
B. Practicum
1. Overview of Plant & Facilities
2. Familiarity of buildings & premises and activities
a. Raw packaging materials warehouse
b. Quarantine area
a. Equipment
b. Weighing Area
c. Production and Process Control
d. Quality Control Laboratory
e. Research and Development Activities
f. Personnel
g. Synthesis and Evaluation
II. QUANTITY OF WORK
A. Productivity
B. Accomplishment of Assigned Task
III. QUALITY OF WORK
A. Accuracy and Efficiency
B. Initiative and Cooperation
IV. STUDENT PERSONAL CHARACTERISTICS
A. Communication Skills
B. Ability to Work with Others
C. Professional Conduct
D. Courtesy to Personnel
E. Honesty and Integrity
F. Punctuality
G. Neatness and Composure
H. Interest and Attention

5
5
5
5

4
4
4
4

3
3
3
3

2
2
2
2

1
1
1
1

5
5
5
5
5
5
5
5
5

4
4
4
4
4
4
4
4
4

3
3
3
3
3
3
3
3
3

2
2
2
2
2
2
2
2
2

1
1
1
1
1
1
1
1
1

5
5

4
4

3
3

2
2

1
1

5
5

4
4

3
3

2
2

1
1

5
5
5
5
5
5
5
5

4
4
4
4
4
4
4
4

3
3
3
3
3
3
3
3

2
2
2
2
2
2
2
2

1
1
1
1
1
1
1
1

AVERAGE : _______________________
OTHER COMMENTS: _______________________________________________________________________________________
_______________________________________________________________________________________
__________________________________
PRINTED NAME AND SIGNATURE
OF SUPERVISING PHARMACIST
LICENSE NO.: ____________________
PTR : ____________________________
DATE ISSUED : ___________________
Rating Interpretation:
5 = Excellent, exceeds general requirements
2 = Needs Improvement

4 = Very Good
3 = Satisfactory, meets general requirements
1= Unsatisfactory

SAINT LOUIS UNIVERSITY

SCHOOL OF NATURAL SCIENCES
DEPARTMENT OF PHARMACY
PERFORMANCE EVALUATION REPORT
FOR

COMMUNITY

PHARMACY STUDENT TRAINEE

NAME OF STUDENT : ____________________________________________________________________________________________

NAME AND ADDRESS OF ESTABLISHMENT : ______________________________________________________________________
______________________________________________________________________
DATE STARTED : ___________________________
DATE ENDED: ______________________________
EVALUATION PARAMETERS

RATING SCALE

I. JOB KNOWLEDGE
A. Background Information/General Orientation
1. Organizational Set-up
(Lines of authority/ manpower)
2. Facilities
2
a. Office and Administration
b. Pharmacy
3. Company Policies
4. Laws, Regulations and Other Pharmacy References
B. Practicum
1. Merchandising (Display and Arrangement of Stocks)
2. Trainee-patient Interaction
a. Initial (Reading and Interpretation of Prescription)
b. Final (Patient Counseling and Drug Information)
3. Filling of Prescription with the Pharmacist
3
a. Compounding and Labeling
4
b. Packaging or Repacking
5
c. Preparation of Stock Solutions
6
d. Proper Handling of Ethical Drugs
7
e. Proper Handling of Dangerous and Emergency Drugs
4. Pricing of Prescriptions
5. Recording of Prescriptions
6. Drug Procurement and Inventory Control
7. Product Knowledge/Information
8
a. Classification of Drugs
9
b. Therapeutic Use
10
c. Nomenclature
II. QUANTITY OF WORK
A. Productivity
B. Accomplishment of Assigned Task
III. QUALITY OF WORK
A. Accuracy and Efficiency
B. Initiative and Cooperation
IV. STUDENT PERSONAL CHARACTERISTICS
A. Communication Skills
B. Ability to Work with Others
C. Professional Conduct
D. Courtesy to Personnel and Patients
E. Honesty and Integrity
F. Punctuality
G. Neatness and Composure
H. Interest and Attention

5
5
5

4
4
4

3
3
3

2
2
2

1
1
1

5
5

4
4

3
3

2
2

1
1

5
5
5
5
5
5
5
5

4
4
4
4
4
3
4
4

3
3
3
3
3
3
3
3

2
2
2
2
2
2
2
2

1
1
1
1
1
1
1
1

5
5
5

4
4
4

3
3
3

2
2
2

1
1
1

5
5

4
4

3
3

2
2

1
1

5
5

4
4

3
3

2
2

1
1

5
5
5
5
5
5
5
5

4
4
4
4
4
4
4
4

3
3
3
3
3
3
3
3

2
2
2
2
2
2
2
2

1
1
1
1
1
1
1
1

AVERAGE: ________________________
OTHER COMMENTS: _______________________________________________________________________________________
_______________________________________________________________________________________

__________________________________
PRINTED NAME AND SIGNATURE
OF SUPERVISING PHARMACIST
LICENSE NO.: ____________________
PTR : ____________________________
DATE ISSUED : ___________________
Rating Interpretation:
5 = Excellent, exceeds general requirements
2 = Needs Improvement

4 = Very Good
3 = Satisfactory, meets general requirements
1= Unsatisfactory

SAINT LOUIS UNIVERSITY

SCHOOL OF NATURAL SCIENCES
DEPARTMENT OF PHARMACY
PERFORMANCE EVALUATION REPORT
FOR

HOSPITAL PHARMACY STUDENT TRAINEE

NAME OF STUDENT : ____________________________________________________________________________________________
NAME AND ADDRESS OF ESTABLISHMENT : ______________________________________________________________________
______________________________________________________________________
DATE STARTED : ___________________________
DATE ENDED: ______________________________
EVALUATION PARAMETERS

RATING SCALE

I. JOB KNOWLEDGE
A. Background Information/General Orientation
1. Organizational Set-up
a. Hospital
b. Hospital Pharmacy
c. Duties and Responsibilities
2. Facilities
h. Office and Administration
i. Pharmacy
3. Company Policies
a. General Hospital Policies
b. Hospital Pharmacy Policies
c. Student Trainee Policies
4. Laws, Regulations and Other Pharmacy References
B. Practicum
1. Merchandising (Display and Arrangement of Stocks)
2. Trainee-patient Interaction
a. Initial (Reading and Interpretation of Prescription)
b. Final (Patient Counseling and Drug Information)
3. Filling of Prescription with the Pharmacist
a. Compounding and Labeling
b. Packaging or Repacking
c. Preparation of Stock Solutions
d. Proper Handling of Ethical Drugs
e. Proper Handling of Dangerous and Emergency Drugs
4. Pricing of Prescriptions
5. Recording of Prescriptions
6. Drug Procurement and Inventory Control
7. Product Knowledge/Information
a. Classification of Drugs
b. Therapeutic Use
c. Nomenclature
II. QUANTITY OF WORK
A. Productivity
B. Accomplishment of Assigned Task
III. QUALITY OF WORK
A. Accuracy and Efficiency
B. Initiative and Cooperation
IV. STUDENT PERSONAL CHARACTERISTICS
A. Communication Skills
B. Ability to Work with Others
C. Professional Conduct
D. Courtesy to Personnel and Patients
E. Honesty and Integrity
F. Punctuality
G. Neatness and Composure
H. Interest and Attention

5
5
5

4
4
4

3
3
3

2
2
2

1
1
1

5
5

4
4

3
3

2
2

1
1

5
5
5
5

4
4
4
4

3
3
3
3

2
2
2
2

1
1
1
1

5
5

4
4

3
3

2
2

1
1

5
5
5
5
5
5
5
5

4
4
4
4
4
3
4
4

3
3
3
3
3
3
3
3

2
2
2
2
2
2
2
2

1
1
1
1
1
1
1
1

5
5
5

4
4
4

3
3
3

2
2
2

1
1
1

5
5

4
4

3
3

2
2

1
1

5
5

4
4

3
3

2
2

1
1

5
5
5
5
5
5
5
5

4
4
4
4
4
4
4
4

3
3
3
3
3
3
3
3

2
2
2
2
2
2
2
2

1
1
1
1
1
1
1
1

AVERAGE: ________________________
OTHER COMMENTS: _______________________________________________________________________________________
_______________________________________________________________________________________
__________________________________
PRINTED NAME AND SIGNATURE
OF SUPERVISING PHARMACIST
LICENSE NO.: ____________________
PTR: _____________________________
DATE ISSUED: ____________________
Rating Interpretation:
5 = Excellent, exceeds general requirements
2 = Needs Improvement

4 = Very Good

3 = Satisfactory, meets general requirements

1= Unsatisfactory