Level I Fieldwork Collaboration Form


Occupational Therapy Assistant Program


Fieldwork Coordinator/Educator:  Please review the objectives listed below and determine if they can be met with the resources at your facility.  Please indicate with a check mark in the column next to those that apply.  If your facility has other site specific, Level I objectives, please list or attach them to this form.


Please email or fax to: Occupational Therapy  mailto: occupationaltherapy@trinitydc.edu  202-884-9308 (f)


The fieldwork educator and student should review these goals on the first day so that the student is aware of the expectations for fieldwork in this setting.


Facility Name: ________________________________________________________________________________________________________


Facility Address:______________________________________________________________________________________________________


Fieldwork Coordinator/Educator: _________________________________________________________________________________



_____________ Pediatric

_____________ Psychosocial/Behavioral Health

_____________ Adult Physical Rehab

_____________ Community-based

_____________ Geriatric



Program Facility check applicability
  1. Demonstrate professional behaviors of occupational therapy personnel.
  2. Understand and apply ethical values, roles and responsibilities as outlined by the American Occupational Therapy Association (AOTA) and appropriate regulatory agencies.
  3. Articulate the occupational therapy supervision process in this setting
  4. Apply critical thinking and clinical reasoning skills in written and oral communication as well as collaboration with other health professionals, families and caregivers
  5. Identify appropriate service delivery options for OT practitioners in this setting
  6. Demonstrate the ability to gather relevant data through occupational profile, medical record and or client’s chart to understand the needs of the client.
  7. Demonstrate effective therapeutic use of self during patient, family and caregiver interactions
  8. Identify two (2) or more appropriate group or individual interventions to improve patient engagement in occupations based off of psychosocial, cognitive and emotional assets and deficits.


List Level I site-specific objectives here if applicable:

Facility objectives















Signature:_________________________________________________________                 Date:__________________________________

Fieldwork Coordinator/Educator



Adapted from: The Essential Guide to Occupational Therapy Fieldwork Education: Resources for Today’s Practitioners.  Provided by Donna M. Costas, MS, OTR/L Academic Fieldwork Coordinator, State University of New York at Stony Brook, School of Health Technology and Management.