Clinical Preceptor Evaluation

Please complete the following evaluation of your Clinical Preceptor. These evaluations will not be seen by your C.P. A summary of this information will be given to the C.P. after your clinical rotation has ended.

Clinical Preceptor Name *
Date Date * / MM / DD YYYY
Clinical Assignment *
Section Break

Rate your Clinical Preceptor using the following scale:
5 = 100% of the time/Always
4 = 75% of the time/Most of the time
3 = 50% of the time/Sometimes
2 = 25% of the time/Rarely
1 = 0% of the time/Never
1. Working expectations were made clear at the beginning of my assignment. *
2. Evaluation standards were explained, followed, and fair. *
3. Preceptor was approachable and wiling to answer questions. *
4. Preceptor was receptive to comments and suggestions. *
5. Instructor was punctual for appointments. *
6. Instructor's attitude showed interest, concern, and respect. *
7. Instructor explained rules, regulations, and procedures for the assigned clinical setting. *
8. Instructor was accessible for communication via telephone or in person. *
9. Instructor let me know if there were changes in schedule, practices, etc., in a reasonable time frame. *
10. Instructor provided real life experiences when available. *
11. Instructor served as a role model in relation to morals, values, and ethics. *
12. Instructor provided proper feedback regarding my clinical skills. *
13. Instructor provided ways to improve on my weaknesses. *
14. This clinical assignment challenged my knowledge and skill level. *
15. Overall, how would you rate your experience with this preceptor. *
Instructor helped me in the development of knowledge & skills in the following areas:
1. Taping and equipment fitting *
2. First-aid/CPR-AED/Oxygen Administration *
3. Injury Management/Modality Application *
4. Record Keeping *
5. Communication *
6. Evaluation and Assessment *
Rehabilitation *
Contact time:
Did you have anytime or days where you were left unsupervised? *

Did you have anytime or days where you were left unsupervised? Yes No
If YES, please explain the circumstances for each instance.
Did you travel with the team during this clinical rotation? *

Did you travel with the team during this clinical rotation? Yes No
Were you ever put into a situation that you were not prepared to handle or felt was unfair? *

Were you ever put into a situation that you were not prepared to handle or felt was unfair? Yes No
If YES, please explain.
Weaknesses of the preceptor *
Strengths of the preceptor *
Suggestions for improvements of preceptor or clinical assignment *
Additional comments

Clinical Preceptor Evaluation

Clinical Preceptor Evaluation

Section Break

Instructor helped me in the development of knowledge & skills in the following areas:

Contact time: