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STUDENT INFORMATION:

1/26/24

Student Name: Ashley

Renee

Owens

Date:

First

Middle

Last

Semester:

Site Name:

Practice Setting:

Student ID:

Student’s School:

Course Number:

Hours Completed:

FW Sequence:

1☐ 2☐ 3☐ 4☐ 5☐ 6☐

PRIMARY FWEd INFORMATION

FWEd Name:

Past Experience:

First

Last

Credentials

(# of FWI Students)

(# of FWII

students)

FWEd License #:

FWEd Credentials:

□ OT: OTA:

Years of Experience:

□ Other:

Have you attended the AOTA FWEd Certificate Course? ☐ Yes ☐ No

If other:

U

Unacceptable

Performance is weak in most required tasks and activities. Work is frequently unacceptable.

B

Below Standards

Opportunities for improvement exist; however, student has not demonstrated adequate response to feedback. Performance is occasionally unacceptable.

M

Meets Standards

Carries out required tasks and activities. This rating represents good, solid performance and should be used most often.

E

Exceeds Standards

Frequently carries out tasks and activities that surpass requirements. At times, performance is exceptional.

O

Outstanding

Carries out tasks and activities in consistently outstanding fashion. Performance is the best that could be expected from any student.

THE STUDENT:

U B M E O

1. Articulates values and beliefs of occupational therapy.

Verbalizes definition of occupational therapy as relevant to FW setting or audience. COMMENTS:

2. Utilizes relevant evidence to make informed practice decisions.

Connects class concepts to FW through inquiry or discussion. Articulates value of using evidence- based practice. Identifies and provides evidence that is relevant to setting or clients.

COMMENTS:

U B M E O

1. Time management skills.

Consider student’s ability to be prompt, arriving and completing assignments on time. COMMENTS:

2. Organization.

Consider student’s ability to set priorities, be dependable, be organized, and follow through with responsibilities.

COMMENTS:

3. Engagement in FW experience.

Consider student's apparent level of interest, level of active participation while on site, and investment in individuals and treatment outcomes.

COMMENTS:

4. Self-directed learning.

Consider student’s ability to take responsibility for own learning and to demonstrate motivation.

COMMENTS:

5. Reasoning and problem solving.

Consider student’s ability to use self-reflection; willingness to ask questions; ability to analyze, synthesize, and interpret information; and understand OT process.

COMMENTS:

6. Written communication.

Consider student’s ability to use proper grammar and spelling, legibility of work, successful completion of written assignments, and documentation skills.

COMMENTS:

7. Initiative.

Consider student’s initiative, ability to seek and acquire information from a variety of sources, and demonstrate flexibility as needed.

COMMENTS:

8. Observation skills.

Consider student’s ability to observe relevant behaviors related to occupational performance and client factors and to verbalize perceptions and observations. COMMMENTS:

9. Participation in supervisory process.

Consider student’s ability to give, receive, and respond to feedback; seek guidance when necessary; and follow proper channels of communication.

COMMENTS:

10. Verbal communication and interpersonal skills with patients/clients, staff, and caregivers.

Consider student’s ability to interact appropriately with individuals, such as eye contact, empathy, limit-setting, respectfulness, use of authority, and so forth; degree and quality of verbal interactions; use of body language and non-verbal communication; and exhibition of confidence. COMMMENTS:

11. Professional and personal boundaries.

Consider student’s ability to recognize and handle personal and professional frustrations; balance personal and professional obligations; handle responsibilities; work with others cooperatively, considerately, and effectively; and be responsive to social cues.

COMMENTS:

12. Use of professional terminology.

Consider student’s ability to respect confidentiality; appropriately apply professional terminology (e.g., Occupational Therapy Practice Framework terms and OT acronyms/abbreviations) in written and oral communication.

COMMENTS:

THE STUDENT:

U B M E O N/A

1. Contributes to screening/evaluation process.

Communicates observations. Identifies resources for evaluation process. Could include chart review.

COMMENT:

2. Completes an interview and drafts an occupational profile.

COMMENT:

3. Identifies potential goals from evaluation process.

COMMENT:

4. Drafts documentation consistent with practice setting.

COMMENT:

THE STUDENT:

U B M E O N/A

1. Contributes to intervention process.

Could include preparing clinic area and identifying resources and evidence. COMMENT:

2. Identifies interventions consistent with client evaluation and goals.

COMMENT:

3. Identifies (verbal or written) interventions consistent with client-centered approach, and provides clinical reasoning for interventions identified.

COMMENT:

4. Engages in and values evidence-based practice by seeking evidence to support or negate intervention approach.

COMMENT:

5. Administers interventions that are occupation-based and client-centered within guidelines of facility.

COMMENT :

6. Recognizes (verbal, written, or demonstration) need to modify interventions on basis of client response.

COMMENT :

7. Recognizes (verbal, written, or demonstration) need to modify or terminate intervention plan on basis of client response.

COMMENT:

8. Drafts documentation for intervention using typical procedures used in FW practice setting.

COMMENT: