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UNIVERSITY OF UTAH
COLLEGE o F H EALTH Division of Occupational Therapy
FIELDWORK I OBSERVATION OF STUDENT PERFORMANCE
Student's Name: 1,€(£.,ICa Grr 1--::io Fieldwork Facility: Pa I rner (()i..J ~r-+-
supervisor's Name: Ke 111 f?x:-,V'J-e r Dates of FW: VJ r 2.:S - f---p r I I I 'i ' 2JJ / 7
Pl ease c heck the most aooropnate rating:
Professional Behavior Needs Not
The student: Outstanding Adequate Improvement Observed
1. Conforms to institution's dress code. i'i
2. Is responsible and dependable in attendance and promptness.
3. Initiates and completes all assignments promptly. ',,\
4. Communicates effectively with other professionals/staff. Listens and speaks at '
appropriate times.
5. Contributes toward open communication with supervisor. Gives and receives feedback
.x
aoorooriatelv. \,
6. Establishes and maintains therapeutic relationships with clients and their families. y
7. Presents reports in a clear & professional manner. ex
8. Demonstrates professional values and ethics. {X
9. Maintains the confidentiality of others. ~'

10. Seeks information and asks relevant questions. Uses resources and time effectively. .x
11 . Follows through with suggestions made by supervisor. A,
12. Seeks challenges and demonstrates enthusiasm for fieldwork experiences. i
13. Demonstrates independence when appropriate.
14. Flexible: effectively adjusts to changes; adjusts priorities without difficulty. ('
Related to Educational Objectives Needs Not
The student has: Outstanding Adequate Improvement Observed
15. Developed an increased comfort level interacting with persons who have disabilities,
emotional problems, or osvchiatric disorders. '\
16. Described the needs of clients served by the agency/facility.
17. Demonstrated respect for the values and diversity of persons with disabilities,
caregivers, staff and volunteers.
18. Demonstrated an attitude of inquiry to enhance creativity and problem solving skills.
19. Observed staff interactions, assessments and/or treatment sessions with agency/facility .(
clients.
20. Participated in group or individual treatment sessions as appropriate depending on the
skill level of the student and the severity of the client's disabilitv/illness. 1
Strengths of the student noted~t this fieldwork:
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Areas the stude t coula work toward 1mprlng-dtSting re~aining fieldwork experiences: j A/,A-u-(

Additional comments:
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AoSupervisor Signature

Please give to the student to return, or mail to:

Jeanette Koski, OTR/L

Academic Fieldwork Coordinator
Division of Occupational Therapy
University of Utah
520 Wakara Way
Salt Lake City, UT 84108-1290