Occupational Therapy Assistant Program

Level I Fieldwork: Evaluation of Student Performance


Student Name: ___________________________________________________________________

Site Name: ______________________________________________________________________

Fieldwork Educator(s) Name(s):______________________________________________________

Rotation: ________________________________________________________________________


  (3) (2) (1) (N/A) Comments
Attendance- arrived on time          
Appearance- dressed appropriate to setting          
Observed rules and regulations of the department          
Asked appropriate questions and sought guidance as necessary          
Received, processed, and implemented feedback appropriately          
Demonstrated motivation to learn and actively participated in clinical experience          
Clinical skill and competency          
Interacted appropriately, was respectful, and   demonstrated appropriate verbal, non-verbal, and written communication with patients/clients, caregivers, staff, etc          
Respected patient/client, caregiver and staff diversity          
Identified relevant motor, sensory, cognitive and psychosocial assets and functional deficits related to occupational performance          
Discussed or demonstrated site specific clinical intervention skills related to improving occupational performance          
Discussed or demonstrated ability to set intervention priorities          

Please complete this form to assess the student’s performance during their level one fieldwork. Please email or fax completed and signed form to Mrs. Lisa Simmons at SimmonsLi@trinitydc.edu or (202) 884-9308.



Grading Scale:

(3)-Acceptable: Student consistently met the minimal standards by carrying out required tasks and activities with close supervision.   Student responded appropriately to feedback.

(2)- Below Average: Performance was below average and significant opportunities for improvement exist.

(1)- Unacceptable: Performance was consistently unsafe, unethical or went against facility policies. Student did not modify behavior following feedback.


Fieldwork Educator(s) Signature: __________________________________________________


Student’s Signature: ____________________________________________________________