Midterm Evaluation CI

Please fill this out prior to our midterm conference as this will guide how I conduct our meeting that day.
Name: 


A red asterisk (*) indicates required questions.

  1. Student name*


  1. Is the student on time and prepared?*
    Yes
    No


  1. Is the student dressed to the standard of the department*
    Yes
    No


  1. Does the student avoid using electronic devices during work times?
    (phones, computer, smart watch, etc..)*
    Yes
    No


  1. Is the student interacting appropriately with patients?*
    Yes
    No


  1. Is the student interacting appropriately with other department staff?*
    Yes
    No


  1. Is the student receptive to constructive feedback?*
    Yes
    No


  1. Does the student use patient language during treatment sessions?*
    Yes
    No


  1. Does the student demonstrate good active listening skills?*
    Yes
    No


  1. Is the student asking questions before, during, and/or after treatment sessions?*
    Yes
    No


  1. Does the student show interest during shadowing opportunities?*
    Yes
    No


  1. Has there been a concern about the student's knowledge during interventions?*
    Yes
    No


  1. Does the student use proper documentation techniques?*
    Yes
    No


  1. Has there been any safety concerns during patient care?*
    Yes
    No


  1. Does the student show an understanding of precautions and contraindications during intervention?*
    Yes
    No


  1. Do you feel we need to meet separately?


  1. Please provide any midterm comments or concerns here:





Physical Therapist Assistant Program
Physical Therapist Assistant Instructor
Lake Area Technical Institute