EMT Clinical Evaluation Form

Lets preceptors grade emergency medical students during clinical rotations on professional attitude, punctuality, knowledge and hands-on skills. Every rotation gets scored against uniform criteria and signed off by the preceptor.

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Clinical site*

Student*

Start date of clinical rotation*

How well did this student display the professional attitudes and behaviors expected of an EMS provider?

Excellent Good Needs improvement Unsatisfactory

Did this student arrive on time for the scheduled clinical activity, in full clinical uniform? (Late arrivals and students out of uniform should not be permitted to stay for the clinical experience)

Yes, on time and in full uniform Arrived late Out of uniform Did not attend

How well did this student display the knowledge expected of an EMT student?

Excellent Good Needs improvement Unsatisfactory

How well did this student perform the skills and competencies expected of an EMT student?

Excellent Good Needs improvement Unsatisfactory

Preceptor*

Preceptor ID number

Signature*

Sign here

Please enter an email address if you would like to be contacted about this student

Comments

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