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Home | Majors, Degrees, & Certificates | Emergency Medical Services (NDP.EMS) | Preceptor Evaluation

Preceptor Evaluation

* Required Fields

1: Dangerous 2: Needs Improvement 3: Acceptable 4: Proficient

*Student Name:

*Date:

*Patient Assessment and Rapport

N/A    1    2    3    4

*IV/IO Skills

N/A    1    2    3    4

*Medication Administration

N/A    1    2    3    4

*Airway Management

N/A    1    2    3    4

*ECG Interpretation

N/A    1    2    3    4

*Waveform Capnography

N/A    1    2    3    4

*Cardiac Electrotherapy (Pace, Defibrillation, Cardioversion)

N/A    1    2    3    4

AFFECTIVE DOMAIN SHIFT EVALUATION

1: Dangerous 2: Needs Improvement 3: Acceptable 4: Proficient

*Arrival and Preparation (Student arrived at the clinical session on time and was dressed appropriately)

N/A    1    2    3    4

*Communication and Interpersonal Skills (Student demonstrated the ability to communicate clearly with all medical, team, and community memebers)

N/A    1    2    3    4

*Attitude (Student takes initiative and shows interest in clinical work, accepts contructive criticism well, and takes responsibility for self-improvement)

N/A    1    2    3    4

*DECISION MAKING SKIlLS (Student makes appropriate patient care decisions relevant to pre-hospital care based on adequate information and understanding)

N/A    1    2    3    4

*Comments:

Please enter first and last name for electronic signature:

*Preceptor Signature:

x

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MATTOON, IL 61938

217-234-5253

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