The Ohio State University School of Health & Rehabilitation

Occupational Therapy
Evaluator: Amy Johnson - FW Educator Subject: Shannon Joyce - Level 1 Student

Activity: Level One FW 6389 School Site: Olentangy Local District

Evaluation Type: Fieldwork Level I Evaluation Completion Date: 11/09/2018

Request Date: 10/19/2018

Period: Level I Schools 2018 Dates of Activity: 10/10/2018 To 12/05/2018

Subject Participation Dates: 10/10/2018 To 12/05/2018

STUDENT LEVEL I EVALUATION OF PROFESSIONALISM

Evaluation form developed from: Napier, B. (2011). Occupational therapy fieldwork survival guide: A student planner, 2nd ed.
Bethesda, MD: AOTA Press.

 (Question 1 of 5  - Mandatory ) 

STUDENT NAME Shannon Joyce

Number of Hours Completed: 42.5

FACILITY SUPERVISOR- NAME and CREDENTIALS/TITLE: Amy Johnson OTR/L

Years of Experience: 18 (12 in schools)

Supervisor Email Address (for CEU certificate) amy_johnson@olsd.us

FACILITY NAME: Indian Springs Elementary/Olentangy Local Schools

 (Question 2 of 5  - Mandatory ) 
Please check the box that indicates the student's level of performance
N "Needs Improvement" = Opportunities for improvement and work is occasionally unacceptable
M "Meets Standards" = Carries out required tasks and activities. Solid performance.
N M E
E "Exceeds Standards" = Carries out tasks and activities that often surpass requirements. Performance is the best
that can be expected. This should be used only for strengths.

**Comments required for all scored as an N**

1. Dependability (consider ability to arrive on time, follows through on assignments, notifies supervisor of schedule X
issues)
2. Competence (consider ability to be prepared, asks for help when needed, ensures safety, comfort, and rights of X
clients)
3. Communication (consider ability to use appropriate level of language, positive non-verbal communication and X
tone, maintain boundaries, responds well to and uses feedback)
4. Integrity (consider ability to respect and maintain confidentiality, act with honesty, accept responsibility for self, X
value and care for the equipment and resources of the facility)
5. Cooperation and Teamwork (consider ability to make positive contributions to the team process, accept group X
decisions, complete own share of the work, give credit to those who deserve it)
6. Empathy/Compassion (consider ability to be non-judgmental and respectful, culturally sensitive, and listen X
actively)
7. Initiative/Self-directed learning (consider ability to be motivated, to seek out opportunities to acquire information X
from a variety of sources, and accept and apply feedback)
8. Professional Appearance (consider appropriate clothing, good personal hygiene, discrete body adornment, X
appropriate body posture and facial expressions that send reassuring messages to clients)
9. Flexibility/Adaptability (consider ability to make change to treatment plan, react to client, make change in self X
after feedback)
10. Assessment Activities (consider choosing correct assessment, adheres to standardization, correctly X
documents results)
11. Intervention Activities (consider matching intervention to assessment and client needs, executes activity
X
without assistance)
Overall Score: Please rate your overall impression of this student's performance X
*In order to pass, needs to obtain an M in this category*

Comments  (Question 3 of 5 ) 

Shannon was well prepared each week when she arrived. She did an excellent job of taking into account students' individual interests as
well as goals when planning treatment activities. The entire fieldwork experience was a lesson in flexibility due to a number of unexpected
circumstances with student absences/testing/field trips, and Shannon was always quick to adapt and jump in with a new plan. She asked
insightful questions and expressed a genuine interest in the students as well as in the process of all of the paperwork and procedures that
go along with school-based OT. Shannon was a pleasure to host as a Level 1 fieldwork student at Indian Springs Elementary, and
anticipate that she will be very successful in future experiences with this population.

Supervisor Electronic Signature:  (Question 4 of 5  - Mandatory ) 

Please enter your name in the text box below-

Amy Johnson

Date:  (Question 5 of 5  - Mandatory ) 
11/07/2018