PHILADELPHIA REGION FIELDWORK CONSORTIUM
STUDENT EVALUATION OF LEVEL I FIELDWORK (2nd ed)
Student Name:
Date:
First
Student ID:
Student’s School:
Type of Degree:
FWEd Name:
FWEd Credentials:
Middle
Last
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First
Last
OT: Click to Select
Non OT: Click to Select
If Other:
Credentials
Semester:
Course Number:
Level I Sequence:
Site Name:
Age Group:
Practice Setting:
SUPERVISION
1. Supervisor provided adequate orientation.
2. There were regularly scheduled feedback sessions.
3. Supervisor effectively provided positive reinforcement.
4. Supervisor effectively provided constructive feedback.
5. Supervisor provided opportunities to discuss background information on clients.
6. Supervisor provided opportunities to discuss application of OT to clients.
Comments:
EXPERIENCE OF THE OCCUPATIONAL THERAPY PROCESS
7. There was opportunity to experience the evaluation process.
8. There was opportunity to experience occupation-based interventions.
9. There was opportunity to experience purposeful interventions.
10. There was opportunity to experience preparatory methods.
11. There was opportunity to experience an intervention approach to create or promote health.
12. There was opportunity to experience an intervention approach to establish or restore client
skills and abilities.
13. There was opportunity to experience an intervention approach to maintain/preserve client
performance capabilities.
14. There was opportunity to experience an intervention approach to modify or revise context or
activity demands to support client performance.
15. There was opportunity to experience an intervention approach to prevent clients with or at
risk for developing occupational performance issues.
Comments:
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If Other:
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FACILITY
16. The environment was conducive to learning.
17. There were adequate opportunities to interface with clients.
18. Facility uses a client-centered approach to treatment.
Comments:
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ASSIGNMENTS
19.
20.
21.
22.
23.
Comments:
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 Philadelphia Region Fieldwork Consortium
OVERALL EXPERIENCE
24. This was a well-planned level I fieldwork.
25. My overall experience was good.
26. What factors facilitated your participation with actual patients or clients in this setting?
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27. What factors limited your participation with actual patients or clients in this setting?
Comments:
CLINICAL SKILLS
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Body mechanics training
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Fine motor coordination training
Gross motor coordination training
Joint protection training
Motor control techniques
Motor learning interventions
NDT interventions
Neuromuscular reeducation
PNF
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Positioning and handling
Sensory re-education
SI interventions
Strength and endurance training
Visual-motor training
Visual-perceptual skills training
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Activity sequencing training
Attention, orientation, concentration
Behavior management
Cognitive-perceptual retraining
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Initiation-termination training
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Arts/crafts
Documentation
Ethics
Games
Leading groups
Therapeutic use of self
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Problem-solving training
Social skills training
Stress management/coping skills
Time management training
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Sensory-Motor
Adaptive equipment
recommend/training
Bathing/showering
Caregiver skills
Community re-integration
Dressing
Eating
Energy conservation training
Feeding
Functional communication skills
(writing, phone, etc)
Functional mobility
Grooming
Health management/maintenance
Home management
Money Management
Oral hygiene
Play/leisure skill development
Safety/emergency training
School-related activity training
Toileting
Transfer training
Work (hardening, ergonomics,
vocational)
Ability to explain OT to others
Cognitive-Psychosocial
Other
Areas of Occupation
Indicate how you experienced the following skills during your fieldwork using the scale below.
1 = Skill not experienced
2 = Participation was limited to observation
3 = Practiced skill with FW supervisor, staff, or other students
4 = Practiced skill with actual patients/clients
*Please print and review with your supervisor, then submit the word document electronically to
Student signature: ______________________________________
FWEd signature: ________________________________________
 Philadelphia Region Fieldwork Consortium