UNIVERSITY OF UTAH | COLLEGE HEALTH Division of Occupational Therapy FIELDWORK | OBSERVATION OF STUDENT PERFORMANCE Student’s Name: (esta Siva Fieldwork Facity: Zidenmourdain Ural Gue- Ms Kas van Supervisor's Name: Pexie. Mufevlad O(R/e , UT Dates of Fw: _¢3/2S/le — CB/AK/AG vee Please check the most appropriate rating: | Professional Behavior Needs Not | The student: i: Outstanding | Adequate | improvement | Observed 1. Conforms to institution's dress code. 2. Is responsible and dependable in attendance and promptness. 3. Communicates effectively with other professionalsistaff. Listens and speaks at Y appropriate times. — 4, Contributes toward open communication with supervisor. Gives and receives feedback SY appropriately. 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 information and asks relevant questions, VY Uses resources and time effectively 9. Follows through with suggestions made by supervisor. 10. Seeks challenges and demonstrates enthusiasm for fieldwork experiences. _ iz 11. Demonstrates independence when appropriate. 12. Flexible: effectively adjusts to changes; adjusts priorities without difficulty. Se 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, Y emotional problems, or psychiatric disorders. | 14. Described the needs of clients served by the agencyfacility. i 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 andor treatment sessions with agency/faclity 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 disability/iliness 19. Observed OTRICOTA role delineation when Certified Occupational Therapy Assistants eA are employed by the agency/facilty. —eit ears, we aide 40 use Wrench ackties “To Evppee PS eee yon Me oe ened oh Sha oxen resid ees and yuter ocospedional vols. She was Kory, 4p venstvudive ees wing to lange howsel€ , ated aktentive to patets’ 1 Trolividuad yeeels and Ske ‘Areas the student could work toward improving surge remaining fieldwork experiences: Resa con vertie duslagig ime agen Wills ae + ay oo awaluokicns and eats wetin prviodg,. i wewd ener confidence in ber. clinical veaseritng and Chat aeplein ean apace ewettt of tm WhewenkionsS ‘Additional comments: XO Qa" and tute ie ‘ Len rw tl crepe cor Supervidor Signatule Please give to the student to return, or mail to: Jeanette Koski, OTRIL Academic Fieldwork Coordinator Division of Occupational Therapy University of Utah 520 Wakara Way Sal Lake Gy, UT 84108-1260