Clinical Rotation Site Evaluation Form
Use this form to evaluate a clinical rotation site, including the learning environment, supervision, educational value, and overall experience during the rotation.
Evaluator and Rotation Details
Evaluator Role
*
Please Select
Student
Resident
Preceptor
Faculty
Other
Rotation Specialty or Department
*
Clinical Site Name
*
Rotation Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rotation End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Clinical Site Evaluation Criteria
Quality of supervision
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Learning opportunities provided
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Professionalism of staff
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Variety of patient cases and exposure
*
Very limited
1
2
3
4
Excellent variety
5
1 is Very limited, 5 is Excellent variety
Clarity of expectations
*
Unclear
1
2
3
4
Very clear
5
1 is Unclear, 5 is Very clear
Communication with site staff
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Access to resources and equipment
*
Very limited
1
2
3
4
Fully adequate
5
1 is Very limited, 5 is Fully adequate
Scheduling and organization
*
Poorly organized
1
2
3
4
Highly organized
5
1 is Poorly organized, 5 is Highly organized
Patient safety practices
*
Needs improvement
1
2
3
4
Excellent
5
1 is Needs improvement, 5 is Excellent
Overall educational value
*
Low
1
2
3
4
Outstanding
5
1 is Low, 5 is Outstanding
Narrative Feedback and Recommendation
Overall comments
Strengths of the site
Areas needing improvement
Overall recommendation
*
Highly recommend for clinical education
Recommend for clinical education
Recommend with reservations
Do not recommend for clinical education
Submit Evaluation
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