Strongly Agree, Agree, Fair, Disagree, Strongly Disagree, Or Not Observed
STUDENT PERFORMANCE EVALUATION
Supervisor ______
Student ______Date ______
The agency supervisor is to complete this form upon evaluation of the performance. This form should be completed at the end of the assigned activities for their internship. This report should be sent to the college supervisor within five (5) calendar days after completion. Please mark your response based upon the following scale:
Strongly Agree, Agree, Fair, Disagree, Strongly Disagree, or Not Observed
4 3 2 1 0
Knowedge and Skills Specific to an Athletic Trainer for the internship setting
The student demonstrates the ability to assume activities related to delivery of athletic training services within the context of this setting.
SAAFairDA SD
43 210N/O
The student demonstrates the intellectual ability (content knowledge) needed for providing services in this setting.
SAAFairDA SD
43 210N/O
The student demonstrates adequate skills in his/her ability to conduct special tests for determining the type of injury or status of the condition.
SAAFairDA SD
43 210N/O
The student demonstrates adequate skills in his/her ability to do initial assessment on the patient’s injury condition for the purpose of establishing a starting point for prescribing rehabilitation.
SAAFairDA SD
43 210N/O
The student demonstrates adequate skills in his/her ability to do ongoing assessment on the patient’s condition for the purpose of continuing/advancing the patient’s rehabilitation.
SAAFairDA SD
43 210N/O
The student demonstrates adequate skills for instructing his/her patient in proper rehabilitation exercises.
SAAFairDA SD
43 210N/O
The student demonstrates adequate skills in applying massage during the rehabilitative process.
SAAFairDA SD
43 210N/O
The student demonstrates adequate skills in applying joint mobilization during the rehabilitative process.
SAAFairDA SD
43 210N/O
The student demonstrates adequate skills in applying stretching techniques during the rehabilitative process.
SAAFairDA SD
43 210N/O
The student demonstrates his/her understanding of rehabilitation protocol for a variety of injury or post-surgical conditions so as to progress a patient through the rehabilitation process appropriately.
SAAFairDA SD
43 210N/O
The student demonstrates proper knowledge for the use of ultrasound during the rehabilitative process.
SAAFairDA SD
43 210N/O
The student demonstrates proper knowledge for the use of electrical muscle stimulation during the rehabilitative process.
SAAFairDA SD
43 210N/O
The student demonstrates proper knowledge for the application of thermal agents during the rehabilitative process.
SAAFairDA SD
43 210N/O
The student demonstrates proper knowledge for the application of cold therapy during the rehabilitative process.
SAAFairDA SD
43 210N/O
The student is knowledgeable in contra-indications for injury or post-surgical therapy and exercise.
SAAFairDA SD
43 210N/O
The student demonstrates adequate skills for communicating with his/her patients (parents).
SAAFairDA SD
43 210N/O
The student demonstrates adequate ability in maintaining records and vital patient information.
SAAFairDA SD
43 210N/O
Professionalism and Behavioral Issues
The student shows an active interest in his/her assignments and performs them in a thorough, accurate and neat manner.
SAAFairDA SD
43 210N/O
The student demonstrates a desire to learn as much as he/she can about the various learning opportunities available within the setting.
SAAFairDA SD
43 210N/O
The student can be relied upon to complete his/her assignments.
SAAFairDA SD
43 210N/O
The student demonstrates a willingness to adapt to new or different styles of injury assessment or rehabilitation.
SAAFairDA SD
43 210N/O
The student was dressed appropriately and demonstrated professionalism in his/her appearance.
SAAFairDA SD
43 210N/O
The student displayed the physical and mental energy and resourcefulness required to get results without the need of urging on the part of his/her supervisor.
SAAFairDA SD
43 210N/O
The student was on time and maintained his/her assigned schedule. If there was a problem, the student contacted the supervisor in the appropriate amount of time.
SAAFairDA SD
43 210N/O
The student considered all available facts before acting. The student utilized his/her knowledge and skill base to think critically before making decisions.
SAAFairDA SD
43 210N/O
The student accepted constructive criticism.
SAAFairDA SD
43 210N/O
Note: Add the score gained. If an N/O was given on an item, do not include that item in the total possible score. Provide the mean (average) score from that possible for this evaluation.
Total Score ______/______Mean Score ______
Additional Comments
Agency Supervisor’s Signature ______Date ______
Student’s Signature ______Date ______