Xavier University - Department of Occupational Therapy - Level I Fieldwork Student Evaluation

Sep 29, 2026

Uploaded by Rizky

Level I Fieldwork Student Evaluation form for Xavier University’s Department of Occupational Therapy. It records student and fieldwork site details, fieldwork dates, educator information, absences, and a required final conference and signatures. The evaluation rates 11 competency areas using a 1–5 scale from well below standards to far exceeds standards, totaling at least 33 points for satisfactory performance. Includes directions, standards context, and comment sections with revision notes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Student and Fieldwork Details

Directions and Final Conference

Educator Information and Comments

Rating Scale (1–5)

Evaluation Items (1–11)

Final Review and Signatures

XAVIER UNIVERSITY DEPARTMENT OF OCCUPATIONAL THERAPY LEVEL I FIELDWORK EVALUATION FORM* STUDENT EVALUATION Student name: Name of fieldwork site: Dates of fieldwork: (circle or highlight dates) Session One: Session Two: Summer/Weekend Session: Total number of hours present at facility: DIRECTIONS: The Standards developed by the Accreditation Council for Occupational Therapy Education (ACOTE) describes the objective of the level one fieldwork experience as being “to introduce students to the fieldwork experience, and develop a basic comfort level with and understanding of the needs of clients” (AJOT, 53, 583-589) . Keeping in mind the focus of level one fieldwork is not to be independent performance, please rate the following statements in each category as to your degree of agreement or disagreement with them concerning the performance of this student. Utilize the descriptors for each item for clarification of expected performance skills. ➢ During the final fieldwork session, have a conference with student discussing your evaluation of him/her and his/her completed learning plan they shared on day one. Sign both completed forms and return the forms to the Academic Fieldwork Coordinator. Fieldwork Educator name: Position: OTR: COTA: Other: Absences: Number of Days/Hours: Specific Dates: Amount of Time Made Up: Reasons for: Please use this area for comments: *(Adapted with permission from the Philadelphia Region Fieldwork Consortium Level One Fieldwork Student Evaluation Form, Journal of Allied Health, Summer 2003, 86-91) . Revised, Xavier University Department of Occupational Therapy June, 2006 Xavier University Department of Occupational Therapy Level I Fieldwork Student Evaluation Student name: Site: Please indicate the student's performance on each item using the rating scale below (circle the appropriate number): 1=Well Below Standards: Performance is weak in most required tasks and activities. Work is frequently unacceptable. 2=Below Standards: Opportunities for improvement exist however student has not demonstrated adequate response to feedback. Work is occasionally unacceptable. 3=Meets Standards: Carries out required tasks and activities. (This rating represents good, solid performance and should be used more than all the others.) 4=Exceeds Standards: Frequently carries out tasks and activities that surpass requirements. At times, performance is exceptional. 5=Far Exceeds Standards: Carries out tasks and activities in consistently outstanding fashion. Performance is the best that could be expected from any student. | 1. Time Management Skills
Consider ability to be prompt, arrive on time, and complete assignments on time. | 1 2 3 4 5 | | --- | --- | | 2. Organization
Consider ability to set priorities, be dependable, be organized, and follow through with responsibilities. | 1 2 3 4 5 | | 3. Engagement in the Fieldwork Experience
Consider student's apparent level of interest, level of active participation while on site; investment in individuals and treatment outcomes. | 1 2 3 4 5 | | 4. Self-Directed Learning
Consider ability to take responsibility for own learning; demonstrates motivation. | 1 2 3 4 5 | | 5. Reasoning/Problem solving
Consider ability to use self-reflection, willingness to ask questions; ability to analyze, synthesize and interpret information; understand the OT process. | 1 2 3 4 5 | | 6. Use of Professional Terminology
Consider ability to respect confidentiality; appropriately apply professional terminology (acronyms, abbreviations, etc) in written and oral communication. | 1 2 3 4 5 | | 7. Initiative
Consider initiative, ability to seek and acquire information from a variety of sources. | 1 2 3 4 5 | | 8. Observation Skills
Consider ability to observe relevant behaviors for performance areas and performance components and to verbalize perceptions and observations. | 1 2 3 4 5 | | 9. Part

FAQs

What is the purpose of the Level I fieldwork evaluation form?

It is used to rate a level one fieldwork student’s performance across defined competency categories, using agreement with expected standards and provided descriptors.

How is the student’s performance scored and what threshold indicates satisfactory results?

Each of the 11 items is rated on a 1–5 scale. The form indicates satisfactory performance requires a minimum of 33 total points, while less than 33 points is unsatisfactory.

What steps are required during the final fieldwork session?

During the final session, the fieldwork educator and student complete a conference discussing the educator’s evaluation and the student’s completed learning plan shared on day one, then both sign and return the completed forms.

Sep 29, 2026

Uploaded by Rizky