Student Apprenticeship Evaluation Form

STUDENT APPRENTICESHIP EVALUATION FORM

HEALTH

Apprenticeship Student Trainee:_________________ Work site:___________________

Mentor Name:(please print)_____________________ Phone Number:______________

RATING:

3 = Able to perform entry-level skills. Has performed job during training program; limited addition training may be required

2 = Has performed job during training program; additional training is required to develop entry-level skills.

1 = Is familiar with process, but is unable to perform job with entry-level skill.

Work Habits

Attendance/Punctuality 3 2 1 0 Takes suggestions 3 2 1 0

Follows company policies 3 2 1 0 Keeps on task 3 2 1 0

Suitability of dress 3 2 1 0 Gets along with others 3 2 1 0

Hygiene/Grooming 3 2 1 0 Quality of work 3 2 1 0

Communication 3 2 1 0 Quantity of work 3 2 1 0

Interest in work 3 2 1 0 Maintains confidentiality 3 2 1 0

Initiative 3 2 1 0 Customer service 3 2 1 0

Keeps accurate records 3 2 1 0 Patient contact 3 2 1 0

Potential for success 3 2 1 0 Asks for help 3 2 1 0

Shows desire to learn 3 2 1 0 Respectful to coworkers 3 2 1 0

Follows instructions 3 2 1 0 Safety habits 3 2 1 0

TOTAL POINTS:__________

GENERAL COMMENTS:___________________________________________________

GENERAL RATING OF STUDENT EMPLOYEE (Please circle the most appropriate letter grade):

Excellent Good Average Unsatisfactory Failing

66-62 61-57 57-53 52-48 47 or below

A+ A A- B+ B B- C+ C C- D+ D D- F

Mentor Signature:_________________________________ Date:_________________