RTW Clinical Site Survey
Exit this survey

1.

1. Enter date: (mm/dd/yyyy)

	MM		DD		YYYY
Date:	Enter date: (mm/dd/yyyy) Date: Month	/	Day	/	Year

2. Are you a student or faculty member?

Are you a student or faculty member? Student

Faculty

3. Class ID

Class ID

4. Course Name

Course Name

5. Clinical Site Name:

	Clinical Site Name
Clinical Site Name:	Clinical Site Name: Clinical Site Name: Clinical Site Name

Other (please specify)

6. Provided opportunities for meeting the clinical objectives and course competencies.

	Excellent	Good	Adequate	Poor	N/A
Check One	*Provided opportunities for meeting the clinical objectives and course competencies. Check One Excellent	Check One Good	Check One Adequate	Check One Poor	Check One N/A

7. Provided opportunities for applying theory in practice.

	Excellent	Good	Adequate	Poor	N/A
Check one	*Provided opportunities for applying theory in practice. Check one Excellent	Check one Good	Check one Adequate	Check one Poor	Check one N/A

8. Provided experiences that are based on current knowledge and practice.

	Excellent	Good	Adequate	Poor	N/A
Check one	*Provided experiences that are based on current knowledge and practice. Check one Excellent	Check one Good	Check one Adequate	Check one Poor	Check one N/A

9. Unit staff served as professional role models.

	Excellent	Good	Adequate	Poor	N/A
Check one	*Unit staff served as professional role models. Check one Excellent	Check one Good	Check one Adequate	Check one Poor	Check one N/A

10. Unit staff supported the student learning experience.

	Excellent	Good	Adequate	Poor	N/A
Check one	*Unit staff supported the student learning experience. Check one Excellent	Check one Good	Check one Adequate	Check one Poor	Check one N/A

11. Is appropriate for future clinical rotations.

	Excellent	Good	Adequate	Poor	N/A
Check one	*Is appropriate for future clinical rotations. Check one Excellent	Check one Good	Check one Adequate	Check one Poor	Check one N/A

12. Any other comments?

Any other comments?

Powered by SurveyMonkey
Create your own free online survey now!

form {display:none;} #jserror {text-align:center;margin-top:50px;}Javascript is required for this site to function, please enable.