Level I Fieldwork Collaboration Form


Master of Occupational Therapy


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: Master of Occupational Therapy  mailto: MOTProgram@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
Level I fieldwork course objectives for Trinity MOT students are as follows:

1.      Apply the AOTA Code of Ethics and Ethics Standards, Core Values and Attitudes of Occupational Therapy Practice, and AOTA Standards of Practice in the fieldwork setting.

2.      Ensure patient safety and confidentiality, including consistent use of standard precautions, observance of relevant Health Insurance Portability and Accountability Act (HIPAA) regulations, and effective patient care skills as appropriate to the setting and scope of practice.

3.      Demonstrate appropriate professional behaviors, including the ability to self-critique performance and accept feedback from peers, fieldwork supervisors, and course instructors.

4.      Identify the roles and value of various disciplines of the inter-professional care team in the delivery of care.

5.      Develop comfort and skill in communicating with clients, caregivers and members of the care team.

6.      Demonstrate respect and appreciation for patients, clients and populations with diverse backgrounds, and consideration of psychological and social factors that influence engagement in occupation.

7.      Demonstrate therapeutic use of self, including one’s personality, insights, perceptions, and judgements, as part of the therapeutic process in both individual and group interaction.

8.      Effectively communicate relevant observations through oral and written means, incorporating professional terminology.

9.      Gather data from client observation, client/caregiver interviews, other professionals, and client records to understand occupational needs.

10.  Demonstrate beginning skills in interpreting evaluation findings to develop a treatment plan using contextually relevant, evidence-based interventions that utilize occupations and activities to support individuals’ occupational performance needs.



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.