11/1/2018 eValue

The Ohio State University School of Health &

Rehabilitation
Occupational Therapy
Student Evaluation

Evaluator: Amanda Corturillo - FW Educator Subject: Kylee Hooper - Level 1 Student

Level One FW 6289 Physical OhioHealth Rehab Hospital
Activity: Function Site: (OHRH)

Evaluation Type: Fieldwork Level I Evaluation Completion 10/11/2018

Date:
Request Date: 09/05/2018

Period: Level I Physical Function 2018 Dates of 08/29/2018 To 10/10/2018

Activity:
Subject Participation 08/29/2018 To 10/10/2018
Dates:

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 Kylee Hooper

Number of Hours Completed: 41
FACILITY SUPERVISOR- NAME and CREDENTIALS/TITLE: Amanda Corturillo, OTR/L
Years of Experience: 2.5
Supervisor Email Address (for CEU certificate) ACorturillo@ohiohealth-rehab.com
FACILITY NAME: Ohiohealth Rehabilitation Hospital

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(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 X

supervisor of schedule issues)
2. Competence (consider ability to be prepared, asks for help when needed, ensures safety, comfort, X
and rights of clients)
3. Communication (consider ability to use appropriate level of language, positive non-verbal X
communication and tone, maintain boundaries, responds well to and uses feedback)
4. Integrity (consider ability to respect and maintain confidentiality, act with honesty, accept X
responsibility for self, 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, X
accept group 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, X
and listen actively)
7. Initiative/Self-directed learning (consider ability to be motivated, to seek out opportunities to X
acquire information from a variety of sources, and accept and apply feedback)
8. Professional Appearance (consider appropriate clothing, good personal hygiene, discrete body
adornment, appropriate body posture and facial expressions that send reassuring messages to X
clients)
9. Flexibility/Adaptability (consider ability to make change to treatment plan, react to client, make X
change in self after feedback)
10. Assessment Activities (consider choosing correct assessment, adheres to standardization, X
correctly documents results)
11. Intervention Activities (consider matching intervention to assessment and client needs,
X
executes activity 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 )

Inpatient Rehab is a very hard, fast paced setting and Kylee was able to be very flexible throughout our days. She
had a very good personality and could easily engage the patient's in conversation as well as during treatment. The
patient's enjoyed interacting with her. She was eager to learn about the various diagnosis we saw during her time.

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

Please enter your name in the text box below-

Amanda Corturillo, OTR/L

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Date: (Question 5 of 5 - Mandatory )

10/11/2018

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