California State University, Monterey Bay
Master of Social Work Program
100 Campus Center, Beach Hall West
Seaside, CA 93955-8001
(831) 582-5316/ Fax: (831) 582-5333
MSW Student Field Placement Orientation Checklist
The following items must be discussed in person by the Agency Field Instructor and the Student to orient the
Student to the Field Placement Agency/Site. The Student and Field Instructor sign and date this Checklist,
indicating that each item has been covered. Please return a copy of this Checklist by the required due date.
Student’s Name
Agency Overview
Check
Review agency mission /purpose statement/philosophy/ goals.
Review organizational structure.
Review the funding auspices and staffing patterns of the agency.
Review the role of the agency in relation to the community and its resources.
Review the identified program(s) or service area(s) where the student is assigned.
Please provide an explanation for any unchecked boxes and if there is a plan to complete the task:
Agency Policies and Protocols
Check
Review the agency policies and procedures manual.
Review the telephone and communication policies / computer utilization, including cell phones and email.
Review the office procedures, supplies, and provisions.
Review the work schedule, including the procedures for reporting late arrivals, absences, lunchtime, and breaks.
Review the agency, department, and/or program meeting schedule/office hours.
Review the agency policy regarding safety and security procedures and protocol, including disaster preparedness (i.e.
personal safety; agency safety; community safety, home visits, hostile clients, etc.).
Explain any policies pertaining to the handling of crisis or other emergencies.
Review the agency parking details and mileage policy.
Review the agency policy regarding harassment and discrimination.
Review the agency policy regarding the Americans with Disabilities Act.
Review the agency policy regarding the HIPAA regulations and legislation.
Review all laws, ethical codes, and social work values regulating social work practice.
Explain specific confidentiality requirements (i.e. consent to release information forms, guidelines for presenting client information
in the classroom). Be sure the student understands the mandatory reporting requirements.
Acquaint student with agency’s clerical and record keeping systems. Show where records are kept and explain the filing
system. Explain necessary procedures like: how to get a letter typed; copying and transcribing information; faxing, mail and
messaging systems.
Please provide an explanation for any unchecked boxes and if there is a plan to complete the task:
8/19/2013
MSW Student Orientation Checklist
1
Field Instructor / Student Responsibilities
Check
Review role, responsibilities, expectations and scope of practice for a MSW student in agency operations.
Discuss any required health and background checks.
Review role and responsibilities of field instructor and task supervisors (if applicable).
Review supervision orientation, preparation and expectations for supervision, and the supervision schedule.
Review emergency consultation with field instructor protocol.
Review the agency orientation schedule, training, and staff development opportunities (if applicable).
Review a plan for monitoring of student hours tracking sheet (by both field instructor and student).
Review how student will represent professional self and identify him/herself as a social work intern with clients, staff, and
professionals.
Review professional boundaries in the students’ relationships with clients, collateral clients, agency staff, etc.
Review the CSUMB MSW Program Field Manual and discuss a plan to begin the MSW Field Learning Agreement.
Please provide an explanation for any uncheck boxes and if there is a plan to complete the task:
The signatures of the Student and the Agency Field Instructor acknowledge that the agency has met the
orientation requirements listed above, and has read and understood all policies, procedures, interns role,
expectations and responsibilities associated with this assigned field placement agency/site and the MSW
Program at CSUMB. This agreement indicates only that the student has been oriented to the field
placement agency/site.
Student’s Print Name:
Student’s Signature:
Date:
Agency Field Instructor’s Signature:
Date:
8/19/2013
MSW Student Orientation Checklist
2