‘© The American Occupational Therapy 2X association, inc. Fieldwork Performance Evaluation For The Occupational Therapy Student sean ave aig d SIGNATURES: NAME: (LAST) (Fi (MIDDLE) | HAVE READ THIS REPOF COLLEGE OR UNW/ERSITY ae ‘SETTING: xo Sopoia, [hy Clinic i hw OF ORGANIZATIONFACIL NUMBER OF PERSONS CONTRIBUTING TO THIS REPORT 5 150 50 ‘ADDRESS: (STREET OR PO BOX) Nid SAT om SAE 7 SandrURe OF RATER = ‘sey WYK | MoT, ota TWPe OF FELOWORK PAINT NAWEIGREDENTIALSPOSTION ORDER OF PLACEMENT:({) 2 3 4 OUTOF(I @ 3 4 rout i 1 2, wor DATES OF PARCEWENT wed ‘OF HOURS COMPLETED NT WaNECREDETIA POSTION FINAL SCORE ‘SUMMARY COMMENTS: (ADDRESSES STUDENT'S CLINICAL COMPETENCE) Laat Sreded , Ur Elect the - eg Cum cpred lon arlonpersinnl SKITS Cod warn lie NeaRATING SCALE FOR STUDENT PERFORMANCE. 4 — Exceeds Standards: Performance is highly shld and senate. ‘This ratings rarely given and would represent the top 5% of al the students you have supervised, ‘3 —Meets Standards: Performance is consistent wth entry-level practice. This aig is infrequently given at midterm and is a strong rating at fina ‘2 —Needs improvement: Perormanceis progressing but sil needs improvement for entry 4vel practice This is a reals rating of performance at midlrm, and some ratings of 2may be reasonable at the ina 1.— Unsatisfactory: Porormanceis below standards and requires ‘development fr eni-ivel practice. This aig is given wen there is ‘a concern about performance. | FUNDAMENTALS OF PRACTICE: Allitems inthis area must be scored ata #3 or above on the final evaluation in order to pass fieldwork. 1. Adheres to ethics: Adheres consistent to the American Occupational Therapy Association Code of Ethics (4) and site's policies and procedures including when relevant, those related to human subject research, Mitem 1 2 @ 4 Final 1 oe ots: 2. Adheres to safety regulations: Adheres consistently to safety regulations, Anticpates potently hazardous stuations anc takes steps to prevent accidents. Midtem 81 @D 3 4 Final 1 2 @® 4 3. Uses judgment in safety: Uses sound judgment in regard to safe- ty of self and others during all feldwork related activites. Mitem 1 G39 4 Final i 2 O 4 ‘Comments on strengths and areas for improvement: * Midterm Final I BASIC TENETS; 4. Cleary and confident articulates the values and bei ofthe cccupatonal therapy profession to cients families, significant oth- es, coleagues, service provides, andthe pub. Midem 1 @> 38 4 Final eed 5. Cleary, confident, and accurately articulates the value of ocou- pation as a method and desired outcome of occupational therapy to cient, families, significant others, coleagues, sence providers, and the publ wien 1 @ 3 4 Final 1 2 (6) 4 6. Clearly, confident, and accurately communicates the roles of the occupational therapist and occupational therapy assistant to cents, families, significant others, coleagues, service providers, ‘and the pubic Maem 1 @) 3 4 Final ed 7. Collaborates with cient, fay, and significant others troughout the occupational therapy process. Mitem = 1 82 G@ 4 Final 1 2 3 & Comments on strengths and arees for improvement: vit Bad oan be nae Foley ~/\ ee Sessions, * Final Gb cna - Good wot prople ot steRATING SCALE FOR STUDENT PERFORMANCE 4 — Exceeds Standards: Perormance is highly sled and se-ntited This rating is rarely given and would represent the top 5% fal the students you have supenised 3.—Meets Standards: Performance is consistent with entryeve practice Ths rig is infrequently given at midterm andis a strong rating at fina 2 —Needs improvement: Perormance is progressing but sill needs improvement for entry-level practic. This isa realistic rating of performance at midterm, and some ratings of 2 may be reasonable at the final 1 — Unsatisfactory: Peormance is below standards and requires development for entry-level practice. This rating is given when there is ‘a concern about performance. Ill. EVALUATION AND SCREENING: 8. Articulates a clear and logical rationale for the evaluation process. Midterm = 4 2 Gs Final 1 2 3 @ 9. Selects relevant screening and assessment methods wile considering such factors as clients priorities, contexts), theories, and evidence-based practice. Midterm 1 a 3 4 Final 1 2 Q@ 4 10. Determines client's occupational profile and performance through appropriate assessment methods. Maem 1G) 4 Final 1 2 ®& 4 11. Assesses client factors and context(s) that support or hinder ‘occupational periormance. Mitem 1 @ 3 4 Final 1 22 0 4 12. Obtains sufficient and necessary information from relevant resources such as cient, familes, significant others, service providers, and records prior to and during the evaluation process. Mitem 1 @ 3 4 Final 1 2 Q 4 13. Administers assessments in a uniform manner to ensure findings are valid and reliable. Midterm = Final 1 304 G4 14, Adjusts/modifies the assessment procedures based on clients needs, behaviors, and culture GQ, 3 4 7 oo Midterm 1 Final 1 16, Interprets evaluation results to determine client's occupational performance strengths and challenges. Midterm = 1 (2\ 3 4 Final 1 Zo ! 16, Establishes an accurate and appropriate plan based on the evaluation results, through integrating multiple factors such as clients priorities, context(s), theories, and evidence-based practice : Mem 1 (2) 3 4 Final 1 2 6 4 417. Documents the results of the evaluation process that demon- strates objective measurement of client's occupational perform ance. Midterm 4 2 @ 4 Final {1 2 3 ‘Comments on strengths and areas for improvement: “Midterm S Thong IV. INTERVENTION: 18. Artculates a clear and logical rationale forthe intervention process. Midem 1 2 CN 4 Final 1 9 6 19. Utilizes evidence from published research and relevant resource to make informed intervention decisions. Midterm = 1 CaN 3 4 Final 1 2 bj 4