Level I Student Performance Evaluation


Student Name:______________________________________________________________________________________

Site Name:___________________________________________________________________________________________

Fieldwork Educator(s)______________________________________________________________________________

Fieldwork Educator phone #:________________________________ email address______________________

Type of facility/patients/Clients: ________________________________________________________________________________________________________

This evaluation is to be used to assess the Level I student’s performance at your fieldwork site. Please keep in mind that Level I practicums are integrated into the course related to the fieldwork setting.  The student should be graded as a Level I student with basic knowledge of the occupational therapy process.  Students should not be expected to perform as an entry-level therapist.  The goal is to provide students with feedback and coaching to correct issues in preparation for Level II internships.


Students are encouraged to get as much “hands on” experience as possible in accordance with what is safe and appropriate as determined by the Fieldwork Supervisor.


On the last day of fieldwork, please discuss grading with the student, sign and give a copy to the student to submit to instructor for grading. Also email or fax: Master of Occupational Therapy occupationaltherapy@Trinitydc.edu or (202) 884-9308.


(3)-Meets Standards: Performance is consistent and student meets or exceeds standards for Level I Fieldwork.  This rating represents a good, solid performance.

(2)-Needs Improvement Performance is progressing, but work may be inconsistent and occasionally unacceptable. Student may modify behavior following feedback.

(1)-Unsatisfactory: Performance is weak.  Work is frequently unacceptable.  Student does not modify behavior following feedback.


3 2 1 N/a Comments
1 Attends regularly and on time
2 Demonstrates professional and well-groomed appearance
3 Observes rules and regulations of the facility/department
4 Demonstrates behaviors consistent with AOTA Code of Ethics
5 Demonstrates motivation to learn, actively participates in clinical experience
6 Asks appropriate questions and seeks guidance to improve
7 Accepts constructive criticism and uses feedback to modify behavior/performance
8 Demonstrates awareness of personal strengths and weaknesses
9 Demonstrates empathy and support of others
10 Demonstrates awareness and understanding of psychological and social factors that influence engagement in occupation
11 Demonstrates awareness and respect for clients and populations with diverse backgrounds
12 Demonstrates ability to organize, prioritize and follow through with responsibilities
13 Respects and maintains confidentiality


14 Adheres to universal and safety precautions


15 Accepts change and manages stressors in a positive and constructive way
16 Identifies and articulates written and/or verbally the role of OT in the practice setting
17 Participates thoughtfully in discussions


18 Effectively uses verbal and non-verbal communication with clients, family and caregivers, staff and supervisor
19 Communicates relevant observations through oral and written means, incorporating professional terminology
20 Demonstrates adequate observation skills related to occupational performance and able to discuss observations appropriately with supervisor
21 Identifies pertinent information from the practice setting (charts, interview of client, staff, etc.) in order to identify client occupational needs
22 Demonstrates adequate written communication skills, uses proper grammar and spelling
23 Demonstrates basic knowledge of diagnoses encountered
24 Begins to develop therapeutic use of self, being attentive and aware of verbal and nonverbal behaviors during interactions with clients
25 Uses clinical reasoning to identify appropriate assessment tools and/or therapeutic activities based on client factors and occupational performance needs (i.e. physical, environmental, psychosocial, cognitive and cultural)


Total (Add each column to obtain score)



Total Score (75) _________________________________ (Minimum score 55 to pass)

Did the student complete a minimum of 30 hours of onsite observation/participation ______ Yes  ______ No


Recommendations/Comments:______________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________






Student Signature: ________________________________________________                        Date:_____________________________

Supervisor Signature: ______________________________________________      Date:_____________________________