Pharmacy Technology Program Time Sheet
Student’s Last NameFirst NameInitial
Externship SiteAddress Phone #
(Please Circle One)
Week: 12345678
Date / Time In / Time Out / Lunch / Hours(including lunch)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total Hours
Comments: ______
______
Supervisor Signature ______Print Name ______
Student Signature ______Date______
Please fax all completed time sheet to the number listed below
(XXX)XXX-XXXX Fax Number
Bi-Weekly Evaluation Sheet
Student Name:______Date:______
Supervisor:______Site: ______
Signature:______Hours to Date: ______
Week: 1 & 23 & 45 & 67 & 8
ASHPGoal(s) / Excell
-ent / Good / Fair / Needs
Improve
-ment / N/A / Comments
Professional Standards
Initiative / 1,5,35,43
Appearance / 1,2,35,43
Time Management / 1,5,35,43
Attendance / 1,5,35,43
Dependability / 1,5,35,43
Follows Office Procedure / 1,2,5,21,35,43
Professionalism / 1,2,4,35,43
Respect for Staff / 1,2,4,35,43
Responsible for his/her actions / 1,2,5,6,7,35,43
Demonstrates Teamwork / 1,2,4,6,7,35,43
Displays Initiative / 1,2,35,43
Understanding of healthcare occupations and the health care delivery system / 1,8,35,43
Understanding of wellness promotion, disease prevention concepts, health practices, environmental factors that impact health, and adverse effects. / 1,9,35,43
Commitment to excellence in the pharmacy profession and to continuing education and training / 1,10,35,43
Knowledge and skills in areas of science relevant to pharmacy technician / 1,11,35,43
Understanding of non-traditional roles of pharmacy technicians / 1,15,35,43
Understanding of major trends, issues, goals and initiatives in pharmacy / 1,14,35,43
Identify and describe emerging therapies / 1,16,35,43
Assist pharmacists with customer service and patient needs / 1,19,35,43
Assist pharmacist in monitoring of Medication Therapy Management / 1,24,35,40,43
Maintain pharmacy facilities and equipment / 1,26,35,43
Properly uses MSDS / 1,27,35,43
Hold current CPR Certification / 1,35,37,38,43
Assist pharmacist in medication reconciliation / 1,35,39,43
Describe current use of technology in healthcare / 1,35,41,43
Understand role of pharmacist vs. pharmacy technician / 1,35,42,43
Understand and apply quality assurance / 1,35,43,44
Other:
Clerical Skills
Data Entry / 1,5,35,43
Back-Up Procedures / 1, 13,17,18,31,34,35,43
Third Party Billing / 1,13,17,18,31,34
Retrieves Data / 1,13,17,18,31,34
Generates Data / 1,13,17,18,31,34
Cash Register / 1,13,17,18,31,34
Telephone Etiquette / 1,13,17,18,31,34
Communication Skills / 1,12,13,17,18,31
Other:
Dispensing Skills Completed (1,3,4,5,13,17,18,31,34)
Receives Rx Info / 1,13,17,18,31,34
Translates Rx / 1,3,13,17,18,21,23,25,29,35,43
Selects Appropriate Meds / 1,3,17,18,21,23,25,29
Knowledge of Brand vs. Generic / 1,317,18,21,23,25,29
Translates Medication Order / 1,17,18,21,23,25,29
Unit Dose / 1,17,18,21,23,25,29
Cart Fill List / 1,3,17,18,21,23,25,29
Restock / 1,3,17,18,20,21,23,25,29
Removes Expired Stock / 1,3,17,18,20,21,23,25,29,36
Prepares Code Boxes / 1,3,17,18,20,21,23,25,29,32,36
Prepares Labels / 1,3,17,18,21,23,25,29,32,45
Other:
Inventory/Compounding Skills
Calculates Accurately / 12,13,23,25,30
Reconstitutes Antibiotics / 12,13,23,25,30
Measures Accurately / 12,13,23,25,30,36
Receives Inventory Orders / 12,13,23,25,30,33
Satellite Orders / 13,23,25,30
Returns & Recalls / 13,23,25,30,33,45
Retrieves/Credits Unused Meds / 13,23,25,30,33
Other:
Aseptic Technique Skills
Follows Aseptic Technique / 13,22,28,30
Cleans Laminar Flow Hood / 13,22,28,30
Organizes Items in Hood / 13,22,28,30
Disposal Procedures / 13,22,28,30
Other:
Additional Comments
Student Comments
Supervisor Signature: ______Date: ______
Pharmacy Technology Final Evaluation Sheet
Student Name:______Date: ______
Site: ______Phone #: ( ) ______
Externship Overall Eight (8) Week Site Evaluation Form
This must be filled out in full by the site supervisor of the externship site
(To be submitted by the student with all final documents required for grade)
Performance
Excellent / Good / Fair / Needs Improvement / Unsatisfactory / CommentsAttitude toward work
Relations with others
Overall quality of work
Overall Attendance
Administrative Skills
Clinical Skills
Cooperation
Leadership
Overall Attitude
Other: ______
Overall Performance: Outstanding ____Very Good ____Good ____Average ____Poor ____
Yes / No / CommentsWould you strongly recommend this extern for employment?
Was this extern a pleasure to work with?
Would you hire this extern?
Supervisor Name: (print) ______
Signature: ______Date: ______
FAX NUMBER (XXX) XXX-XXXX