UNIVERSITY OF UT AH

DIVISION OF OCCUPATIONAL THERAPY

FIELDWORK I OBSERVATION OF STUDENT PERFORl\'lANCE
Student's Name: 1-e~\ c~ Sm 1:[b Fieldwork Facility: PnmC1~ Children~ RQhglo - La~tJ!(1 .
Supervisor' s Name: KGttl CarLCQn Dates ofFW: CGi, IU - OC1· "27 W/71

Please check the most appropriate rating:

Professional Behavior Needs Not

The student: Outstanding Adequate Improvement Observed
l. Confonns to institution ' s dress code.
2 . ls responsible and dependable in attendance and promptness.
3. Communicates effectivelv with other orofessionals/staff. Listens and sneaks at anorooriate times. '-../
4. Contributes toward open communication with supervisor. Gives and receives feedback
aooropriatelv. v
5. Establishes and maintains therapeutic relationships with clients and their families. /
6. Demonstrates professional values and ethics.
7. Maintains the confidentiality of others. ,/

8. Seeks infonnation and asks relevant questions.

Uses resources and time effectivelv.
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9. Follows throuirn with su1uzestions made by suoervisor.
10 . Seeks challenges and demonstrates enthusiasm for fieldwork experiences.
11 . Demonstrates independence when appropriate.
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12. Flexible: effectively adjusts to changes; adjusts priorities without difficulty.
Related to Educational Objectives Needs Not
The student has: Outstanding Adequate Improvement Observed
13. Developed an increased comfort level interacting with persons who have disabilities, emotional
problems, or psychiatric disorders.
14 . Described the needs of clients served bv the agencv/facilitv. v
15. Demonstrated respect for the values and diversity of persons with disabilities, caregivers, staff and
volunteers.
16 . Demonstrated an attitude of inquiry to enhance creativity and problem solving skills.
17. Observed staff interactions, assessments and/or treatment sessions with agency/facility clients.
18. 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.
19. Observed OTR/COTA role delineation when Certified Occupational Therapy Assistants are
employed by the ru?:encv/facilitv. ~)Vt
.,
 Strengths of the student noted at this fieldwork :
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Areas the student could work toward improving during remaining fieldwork experiences:
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Additional comments:

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Student Signature Supervisor ig

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

Jeanette Koski, OTR/L

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