Emergency Medical Technician Clinical Evaluation
Clinical Site
*
Please Select
Baylor Scott and White All Saints Medical Center
Cook Children's Medical Center
Medical City Weatherford
Palo Pinto General Hospital
Texas Health Harris Methodist Fort Worth
Texas Health Willow Park
Walker Pediatrics
Wise Regional Medical Center
Azle Fire Department
Benbrook Fire Department
Bedford Fire Department
Eagle Mountain Fire Department
Grand Prairie Fire Department
LifeCare EMS
MedStar Mobile Healthcare
Mineral Wells Fire Department
Texas EMS
Watauga Fire Department
Wise County EMS
Student
*
Please Select
Armendariz, Tiffany
Cary, Brennan
Cousins, Constance
Dailey, Briana
Dillard, River
Freeman, Jarett
George, Tristan
Gibson, Bryan
Graves , Justin
Hall, William
Halvorson, Gage
Holt, Harrison
McClure, Lance
McLean, William
Robertson, Sydney
Roecker, Brandon
Start Date of Clinical Rotation
*
-
Month
-
Day
Year
Date
Affective Evaluation
How well did this student display professional attitudes and behaviors expected of an EMS provider?
Above expectations
As expected (target)
Below Expectations
Did this student arrive on time for the scheduled clinical / field activity, in full Weatherford College clinical uniform? (Late arrivals and students out of uniform should not be permitted to stay for the clinical experience)
Yes (target)
No
Cognitive Evaluation
How well did this student display the knowledge expected of an Emergency Medical Technician Student?
Above expectations
As expected (target)
Below Expectations
Psychomotor Evaluation
How well did this student perform the skills and competencies expected of an Emergency Medical Technician Student?
Above expectations
As expected (target)
Below Expectations
Preceptor
*
Please enter the preceptors name
Preceptor ID Number
Please enter the preceptors ID (badge) number
Signature
*
Please enter an Email address if you would like to be contacted about this student
Email address is only required if you would like us to contact you about this students clinical activity.
Comments
Please enter any comments you have about this students performance, or anything that may be helpful in improving the EMS Education Program at Weatherford College.
Thank you.
Thank you for precepting this student, and for all the assistance in the educational process of EMS education. Your assistance is paramount to the success of the EMS Program at Weatherford College.
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