Individual Evaluation Printed: 11/1/2018

Subject: Hayley Robinson

Activity/Site: Level One FW 6189 Mental Health at Buckeye Ranch (The)
Time Frame/Partic: Level 1 Mental Health 2018 Community Sites (2/1/2018 to 3/8/2018) / (02/01/2018 -
03/08/2018)
Evaluation Type: Fieldwork Level I Evaluation
Evaluator: Meghan Vesper

001.0 STUDENT NAME

Hayley Robinson

001.0 Number of Hours Completed:

40

001.0 FACILITY SUPERVISOR- NAME and CREDENTIALS/TITLE:

Meghan Vesper, MOT, OTR/L

001.0 Years of Experience:

001.0 Supervisor Email Address (for CEU certificate)

vesper.5@buckeyemail.osu.edu

001.0 FACILITY NAME:

Buckeye Ranch

002.0 1. Dependability (consider ability to arrive on time, follows through on assignments, notifies supervisor of
schedule issues)

1
X 2
3

002.0 2. Competence (consider ability to be prepared, asks for help when needed, ensures safety, comfort, and
rights of clients)

1
X 2
3

Hayley Robinson Level One FW 6189 Mental Health at Buckeye Ranch (The) Page 1
002.0 3. Communication (consider ability to use appropriate level of language, positive non-verbal communication
and tone, maintain boundaries, responds well to and uses feedback)

1
X 2
3

002.0 4. Integrity (consider ability to respect and maintain confidentiality, act with honesty, accept responsibility for
self, value and care for the equipment and resources of the facility)

1
X 2
3

002.0 5. Cooperation and Teamwork (consider ability to make positive contributions to the team process, accept
group decisions, complete own share of the work, give credit to those who deserve it)

1
X 2
3

002.0 6. Empathy/Compassion (consider ability to be non-judgmental and respectful, culturally sensitive, and listen
actively)

1
2
X 3

002.0 7. Initiative/Self-directed learning (consider ability to be motivated, to seek out opportunities to acquire
information from a variety of sources, and accept and apply feedback)

1
X 2
3

002.0 8. Professional Appearance (consider appropriate clothing, good personal hygiene, discrete body adornment,
appropriate body posture and facial expressions that send reassuring messages to clients)

1
X 2
3

002.0 9. Flexibility/Adaptability (consider ability to make change to treatment plan, react to client, make change in
self after feedback)

1
X 2
3

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002.0 10. Assessment Activities (consider choosing correct assessment, adheres to standardization, correctly
documents results)

1
X 2
3

002.0 11. Intervention Activities (consider matching intervention to assessment and client needs, executes activity
without assistance)

1
X 2
3

002.0 Overall Score: Please rate your overall impression of this student's performance
*In order to pass, needs to obtain an M in this category*

1
X 2
3

003.0 Comments

Throughout her rotation at Buckeye Ranch, Hayley did an excellent job establishing relationships with clients and designing
interventions that considered client needs and interests. She consistently demonstrated strong active listening skills and
compassion/empathy. She collaborated well with Buckeye Ranch staff members and her classmates.

004.0 Supervisor Electronic Signature:

Please enter your name in the text box below-

Meghan Vesper, MOT, OTR/L

005.0 Date:

4/8/2018

Hayley Robinson Level One FW 6189 Mental Health at Buckeye Ranch (The) Page 3