graduate program: Occupational Therapy

Level One Fieldwork

Instructions for completing the Level One Fieldwork Evaluation Form

The following instrument is an evaluation tool used to promote exchange of feedback between the fieldwork educator and the occupational therapy student during level one fieldwork.

The student is expected to complete this form at the end of each fieldwork placement, and share their self assessment with their supervisor.

The fieldwork supervisor is asked to complete the form and share it with the student on the last day of fieldwork, and then either mail the form to the Academic Fieldwork Coordinator or ask the student to deliver it to the Academic Fieldwork Coordinator.
If it is determined that the student is having significant difficulties at any time during the placement as identified on the form, the clinical educator is advised to notify the Academic Fieldwork Coordinator and request a conference for problem solving and planning strategies with all parties involved.

The Academic Fieldwork Coordinator can be reached at any of the
following numbers/addresses:

Office phone: 513-745-3104
Cell phone: 513-505-3632
Department phone: 513-745-3150

Email address: millerg@xavier.edu

Office address: Department of Occupational Therapy
Xavier University
3800 Victory Parkway
Cincinnati, Ohio 45207-7341