University of Utah Health - Radiology Observation Tracking Form

Technologist Name:

Student Observer Name:

Name/Location of Clinical Site:

Total Number of Hours Observing:

Diagnostic Radiology (x-ray)

Sonography/Ultrasound

Nuclear Medicine

MRI

Mammography

Date

	Poor	Average/Satisfactory	Excellent
Professionalism	Professionalism Poor	Professionalism Average/Satisfactory	Professionalism Excellent
Curiosity/Questions	Curiosity/Questions Poor	Curiosity/Questions Average/Satisfactory	Curiosity/Questions Excellent
Engagement	Engagement Poor	Engagement Average/Satisfactory	Engagement Excellent
Communication/Interpersonal	Communication/Interpersonal Poor	Communication/Interpersonal Average/Satisfactory	Communication/Interpersonal Excellent
Respect for Patients/Staff/Confidentiality	Respect for Patients/Staff/Confidentiality Poor	Respect for Patients/Staff/Confidentiality Average/Satisfactory	Respect for Patients/Staff/Confidentiality Excellent

Comments regarding scoring:

Yes

Unsure

Comments: