Kingdom of Saudi Arabia Ministry of Higher Education University of Hail College Of Nursing

Nursing Internship Evaluation

Name of Trainee Name of Hosp./ Training Place Clinical Area Inclusive Date

Week # (
Days Saturday Sunday Monday Tuesday Wednesday Legend: DON PLA DRA JDM Check by:

KNOWLEDGE (50%)
DON(20%) PLA(10%) DRA(10%) JDM(10%) ITT(5%)

SKILLS (40%)
PWA(10%) INP(10%) QWP(5%)

Demonstrate Acquired Knowledge Participate in Learning Activities Discuss Rationale for Actions Judgement and Decision Making Noted by:

ITT PWA INP QWP RD

Initiative in Taking Task Perform Work Assignment Identify Needs / Problems Quality of Work Provided Reporting and Documentation

Head Nurse

Clinical Supervisor / CNE Supervisor

uation Form

ATTITUDE (10%)
RD(10%) ETW(1%) ATT(5%) PUNC(2%) GWR(1%) FRR(1%)

GEN.
AVE.(100%)

Task nment blems vided mentation

ETW ATT PUNC GWR FRR

Enthusiasm to Work Attendance Punctuality Good Working Relationship Follow Rules and Regulation

Approved by:

Chief Nurse