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* 1. Please complete this survey and submit.

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* 2. How long has graduate been employed by your company?

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* 3. Which of the following areas is the graduate currently employed?

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* 4. During that time, how long have you personally worked with him/her?

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* 5. On a scale of 1 to 5, where 5 is the best or highest score, how would you rate this employee in each of the following areas?

  0 (N/A) 1 (Poor) 2 (Fair) 3 (Average) 4 (Good) 5 (Excellent)
Job-related conceptual knowledge
Job-related technical knowledge
Attitude toward work
Adaptability
Dependability
Initiative
Interpersonal skills/Employee relations
Quality of work
Quantity of work
Planning and organization
Communications - Verbal
Communications - Written

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* 6. If you had a vacancy, how likely would you be to hire another employee from Mountwest's Physical Therapy Assistant Program?

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* 7. Please rate your employee's performance in the following areas:

  N/A Poor Fair Average Good Excellent
Providing patient care and safety
Performance of assessment skills within the scope of practice
Use of physical agents for patient care
Use of basic therapeutic exercises
Assist with program planning and implementation
Documentation

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* 8. Please rate your employee's performance in the use of specific rehabilitation programs for patients with:

  N/A Poor Fair Average Good Excellent
Orthopedic conditions
Orthotic needs
Prosthetic needs
Cardiac conditions
Pulmonary conditions
Amputees
Adult neurological conditions
Spinal cord injuries
Pediatric conditions
Burns
Hydrotherapy/Wound care

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* 9. In what areas do you feel that this employee was best prepared for his/her present position?

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* 10. In which areas do you feel additional preparation would be helpful?

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* 11. Which of the following describes you?

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* 12. Are you or any of your staff an APTA Credentialed Clinical Instructor? If so, how many:

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* 13. If you have any additional comments, recommendations, etc., please feel free to provide them below.

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