STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE

(SEFWE)

Purpose:

This evaluation serves as a tool for fieldwork sites, academic programs, and students. The main
objectives of this evaluation are to:
 Enable the Level II fieldwork student who is completing a placement at the site to
evaluate and provide feedback to the fieldwork educator[s] and fieldwork setting
 Enable academic programs, fieldwork sites, and fieldwork educators to benefit from
student feedback in order to develop and refine their Level II fieldwork programs
 Provide objective information to students who are selecting sites for future Level II
fieldwork

This form is designed to offer each program the opportunity to gather meaningful and useful
information. Programs may adapt this form to suit their needs.

Instructions to the Student:

Complete the SEFWE before your final meeting with your fieldwork educator(s).
Make a copy of the form for yourself. This form gets submitted to your fieldwork educator
during or after you review your final fieldwork performance evaluation (FWPE). The SEFWE is
signed by you and the fieldwork educator(s).

Instructions to the Fieldwork Educator(s):

Review the SEFWE with the student after the final Fieldwork Performance Evaluation (FWPE)
has been reviewed and signed.
The SEFWE is signed by both the fieldwork educator(s) and the student.
Return both the FWPE and SEFWE promptly upon completion of the fieldwork to the academic
fieldwork coordinator.
STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE
Fieldwork Site:

Address:

Type of Fieldwork:

Placement Dates: from _________________________ to _______________________

Order of Placement: [ ] First [ ] Second [ ] Third [ ] Fourth

Student work schedule:

Hours required: per week
Weekends required Evenings required
Flex/Alternate Schedules Describe:

Identify Access to Public Transportation:

Please write your e-mail address here if you don’t mind future students contacting you to ask you
about your experience at this site: ______________________________________

We have mutually shared and clarified this Student Evaluation of the Fieldwork

Experience report on .
(date)

_________________________________ ____________________________________
__
Student's Signature FW Educator's Signature

_________________________________ _______________________________________
__ __
Student’s Name (Please Print) FW Educator’s Name and credentials (Please
Print)
FW Educator’s years of experience
____________

ORIENTATION—WEEK 1
Indicate the adequacy of the orientation by checking “Yes” (Y) or “Needs Improvement” (I).

TOPIC Adequate Comment

Y I
Site-specific fieldwork objectives
Student supervision process
Requirements/assignments for students
Student schedule (daily/weekly/monthly)
Agency/Department policies and procedures
Documentation procedures
Safety and Emergency Procedures

CLIENT PROFILE

Check age groups worked with List most commonly seen occupational
performance
issues in this setting

Age Occupational Performance Issues

0–5 years old
6–12 years old
13–21 years old
22–65 years old
65+ years old

Describe the typical population:

OCCUPATIONAL THERAPY PROCESS

I. EVALUATION

List assessment tools used Observed Performed

II. INTERVENTION
List major therapeutic interventions frequently used and indicate whether each was provided as
individual, group, or co-treatment, or as a consultation. List other professionals involved.

Types of Intervention Individual Group Co-Tx Consultation

Occupations: client-directed life activities that
match/support/address identified goals

Activities: meaningful to client, address performance

skills and patterns to facilitate occupational
engagement

Preparatory methods: modalities, devices and

techniques. These are provided to the client, no active
engagement

Preparatory tasks: actions that target specific client

factors or performance skills. Requires client
engagement

Education: provides knowledge & enhances

understanding about occupation, health and well-
being to client to develop helpful behaviors, habits,
routines

Training: develops concrete skills for specific goal

attainment. Targets client performance

Advocacy: promotes occupational justice and

empowers clients

Identify theory(ies) that guided intervention:

III. OUTCOMES
Identify the types of outcomes measured as a result of OT intervention provided:
Type of outcome yes no Provide example
Occupational
Performance
Prevention
Health & Wellness
Quality of Life
Participation
Role competence
Well-being
Occupational Justice

**OTPF-III terminology

ASPECTS OF THE ENVIRONMENT

Yes
No
The current Practice Framework was integrated into practice

Evidence-based practice was integrated into OT intervention

There were opportunities for OT/OTA collaboration

There were opportunities to collaborate with other professionals

There were opportunities to assist in the supervision of others—

specify:
There were opportunities to interact with other students

There were opportunities to expand knowledge of community resources

Student work area/supplies/equipment were adequate

Additional educational opportunities provided with comments (specify):

DOCUMENTATION AND CASE LOAD

Documentation Format:

Narrative SOAP Checklist Other:_______________________

Hand-written documentation Electronic
If electronic, name format & program:

Time frame & frequency of documentation:

Ending student caseload expectation: _____ # of clients per week or day

Ending student productivity expectation: _____ % per day (direct care)

SUPERVISION

What was the primary model of supervision used? (check one)

one fieldwork educator : one student
one fieldwork educator : group of students
two fieldwork educators : one student
one fieldwork educator : two students
distant supervision (primarily off-site)
three or more fieldwork educators : one student (count person as fieldwork educator if
supervision occurred at least weekly)

Frequency of meetings/types of meetings with fieldwork educator (value/frequency):

_______________________________________________________________________________
_______________________________________________________________________________
________________________________________________________
__
General comments on supervision:

1 = Strongly disagree
2 = Disagree
3 = Neutral
SUMMARY of FIELDWORK EXPERIENCE 4 = Agree
5 = Strongly agree

Circle one
Expectations of fieldwork experience were clearly defined 1 2 3 4 5
Expectations were challenging but not overwhelming 1 2 3 4 5
Experiences supported student’s professional development 1 2 3 4 5

What particular qualities or personal performance skills should a student have to function
successfully on this fieldwork placement?
_______________________________________________________________________________
_______________________________________________________________________________
________________________

What advice do you have for future students who wish to prepare for this placement?

Study the following evaluations:

_______________________________________________________________________________
_______________________________________________________________________________
________________________

Study the following intervention methods:

_______________________________________________________________________________
_______________________________________________________________________________
________________________

Read up on the following in advance:

_______________________________________________________________________________
_______________________________________________________________________________
________________________

Overall, what changes would you recommend in this Level II fieldwork experience?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________

Please feel free to add any further comments, descriptions, or information concerning your
fieldwork at this center.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
________________________________________________

Would you recommend this fieldwork site to other students? Yes or No

Why or why not?

__________________________________________________________________

______________________________________________________________________________
______
INSTRUCTIONS
One form must be completed for each fieldwork educator who provided supervision. You can
detach this page and make more copies as needed.

Check the box that best describes your opinion of the fieldwork
educator’s efforts in each area 1 = Strongly Disagree
2 = Disagree
FIELDWORK EDUCATOR NAME: 3 = Neutral
___________________________________ 4 = Agree
5 = Strongly agree
FIELDWORK EDUCATOR YEARS OF EXPERIENCE: __________
1 2 3 4 5
Provided ongoing positive feedback in a timely manner
Provided ongoing constructive feedback in a timely manner
Reviewed written work in a timely manner
Made specific suggestions to student to improve performance
Provided clear performance expectations
Sequenced learning experiences to grade progression
Used a variety of instructional strategies
Taught knowledge and skills to facilitate learning and challenge student
Identified resources to promote student development
Presented clear explanations
Facilitated student’s clinical reasoning
Used a variety of supervisory approaches to facilitate student
performance
Elicited and responded to student feedback and concerns
Adjusted responsibilities to facilitate student’s growth
Supervision changed as fieldwork progressed
Provided a positive role model of professional behavior in practice
Modeled and encouraged occupation-based practice
Modeled and encouraged client-centered practice
Modeled and encouraged evidence-based practice
Modeled and encouraged interprofessional collaboration
Modeled and encouraged intra-professional collaboration

Comments: