Rush/Stroger EM Clerkship - End of Shift evaluation

Student Information

Students: Please complete this page and select your evaluator on the next page. Following this please have the faculty member complete the remainder of the evaluation. Surveys are collated and verified based on name entered. Please enter your name the same way for all shifts.

Please note this evaluation is for MEDICAL STUDENTS ONLY. For residents please reference rushem.org for links to resident end-of-shift evaluations.

Question Title

* 1. Last name

Question Title

* 2. First Name

Question Title

* 3. Shift Date

Please enter the shift start time and the date (on which the shift started for overnight shifts)

Date

Time

AM/PM

Question Title

* 4. Clerkship Site

Rush

Rush Oak Park

Stroger