Learning Simulation Observation Form
Use this form to systematically observe and assess participant performance during a learning simulation.
Observer Name
*
First Name
Last Name
Observer Email
*
example@example.com
Observation Date and Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Simulation Title or Scenario
*
Participant Name(s)
*
Role of Participant(s) in Simulation
*
Please Select
Student
Instructor
Facilitator
Observer
Other
Simulation Learning Objectives (select all that apply)
*
Critical Thinking
Teamwork/Collaboration
Communication Skills
Technical Skills
Problem Solving
Other
Observed Behaviors and Skills
*
Rows
Not Observed
Needs Improvement
Satisfactory
Excellent
Communication
1
2
3
4
Teamwork
5
6
7
8
Problem Solving
9
10
11
12
Technical Skill Application
13
14
15
16
Leadership
17
18
19
20
Adaptability
21
22
23
24
Overall Performance Rating
*
1
2
3
4
5
Strengths Observed
Areas for Improvement
Additional Comments or Notes
Submit Observation
Should be Empty: