The Ohio State University School of Health &

Rehabilitation
Occupational Therapy
Student Evaluation

Evaluator: Meghan Vesper - FW Educator Subject: Ashley Hughes - Level 1

Student
Activity: Level One FW 6189 Mental Health Site: OSU Talbot Hall

Evaluation Type: Fieldwork Level I Evaluation Completion 04/11/2018

Date:
Request Date: 02/24/2018

Period: Level 1 Mental Health 2018 Community Dates of 02/01/2018 To 03/08/2018

Sites Activity:
Subject Participation 02/01/2018 To 03/08/2018
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 Ashley Hughes

Number of Hours Completed: 40
FACILITY SUPERVISOR- NAME and CREDENTIALS/TITLE: Meghan Vesper, MOT, OTR/L
Years of Experience: 0
Supervisor Email Address (for CEU certificate) vesper.5@buckeyemail.osu.edu
FACILITY NAME: Talbot Hall
(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 )

Ashley demonstrates a high degree of professionalism and her past work experience is evident. Her skills in leading
groups exceed Level 1 expectations. Her strengths include poise/confidence, mastery of content, pacing, flexibility,
and ability to quickly and thoughtfully respond to client questions and comments.

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

Please enter your name in the text box below-

Meghan Vesper, MOT, OTR/L

Date: (Question 5 of 5 - Mandatory )

04/10/2018