Concord University
Athletic Training Education Program
Athletic Training Student Evaluation: AT 201
Student:___________________________
Rotation Date:______________________
ACI:______________________________
Directions: Please respond to each item with respect to the athletic training student’s clinical performance under
your supervision using the following scale:
0 – no basis for judgment
1 – poor (little or no skill)
2 – fair (skills are less than those at this level)
3 – average (student demonstrates skills consistent with those at this level)
4 – good (demonstrates skill better than most at this level)
5 – excellent (demonstrates a high quality skill exceeding those at this level)
SKILLS & ABILITIES
Assess vitals (i.e., blood pressure, pulse, respirations)
0 1
Use standardized record keeping methods appropriate to level
0 1
Follow proper OSHA guidelines with respect to biohazardus waste
0 1
Assess lower extremity dermatomes during an evaluation
0 1
Assess lower extremity myotomes during an evaluation
0 1
Assess lower extremity deep tendon reflexes during an evaluation
0 1
Obtain a medical history of an individual with an injury to these areas:
0 1
_____lumbar
_____hip/pelvis
____knee
_____foot, ankle, lower leg
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
5
5
5
5
5
5
5
Observe and identify clinical signs and symptoms associated with common injuries, 0 1
and predisposing conditions
_____lumbar
_____hip/pelvis
____knee
_____foot, ankle, lower leg
2
3
4
5
Identify, palpate, and interpret bony landmarks and soft tissue of these areas:
0 1
_____lumbar
_____hip/pelvis
____knee
_____foot, ankle, lower leg
2
3
4
5
Administer active, resistive, and passive range of motion test using standard
0 1
techniques
_____lumbar
_____hip/pelvis
____knee
_____foot, ankle, lower leg
2
3
4
5
Perform commonly used special tests for these areas:
_____lumbar
_____hip/pelvis
____knee
2
3
4
5
0 1
_____foot, ankle, lower leg
Taping, wrapping, and padding
Evaluation and management of heat and cold illnesses
0
0
1
1
2
2
3
3
4
4
5
5
0
0
0
0
0
0
1
1
1
1
1
1
2
2
2
2
2
2
3
3
3
3
3
3
4
4
4
4
4
4
5
5
5
5
5
5
PERSONAL ATTRIBUTES & PROFESSIONAL BEHAVIOR
Neat, clean, and professional appearance
Punctuality and attendance
Positive attitude and enthusiasm
Demonstrates self-confidence
Demonstrates appropriate emotional maturity at all times
Shows respect for the opinions of others
Ability to receive constructive criticism
Show initiative (seeks work without being told)
Demonstrates willingness to learn
Ability to follow instructions
Follows policies and procedures of the clinical setting
Has put forth ALL efforts to gain valuable clinical experience
Develops positive rapport with athletes and coaches
Develops positive rapport with peers and other allied health professionals
Develops a sense of morals and ethics as listed by the NATA
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
Identify STRENGTHS of the student.
Identify AREAS OF IMPROVEMENT for the student to improve upon.
Additional comments.
This evaluation and the student’s self evaluation were jointly reviewed by the ACI and student on
_________________________.
(Date)
ACI Signature:____________________________________
Student Signature:__________________________________
1/09
5
5
5
5
5
5
5
5
5