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Internship Evaluation Form

This document is an internship evaluation form for a clinical engineering program. It contains 14 criteria for evaluating an intern's performance during their internship such as fulfillment of objectives, academic preparation, initiative, independence, quality of work, problem solving skills, dependability, acceptance of feedback, and communication. For each criterion, the supervisor is asked to select the category that best describes the intern's performance and provide any comments. At the end, the supervisor provides an overall performance rating and indicates whether they would rehire the intern. The form is to be completed by the intern's direct supervisor and returned to the program contact by the end of the internship.

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Muhammad Ali
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51 views4 pages

Internship Evaluation Form

This document is an internship evaluation form for a clinical engineering program. It contains 14 criteria for evaluating an intern's performance during their internship such as fulfillment of objectives, academic preparation, initiative, independence, quality of work, problem solving skills, dependability, acceptance of feedback, and communication. For each criterion, the supervisor is asked to select the category that best describes the intern's performance and provide any comments. At the end, the supervisor provides an overall performance rating and indicates whether they would rehire the intern. The form is to be completed by the intern's direct supervisor and returned to the program contact by the end of the internship.

Uploaded by

Muhammad Ali
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CLINICAL ENGINEERING PROGRAM INSTITUTE OF BIOMATERIALS AND BIOMEDICAL ENGINEERING UNIVERSITY OF TORONTO 164 College Street, Room 407, Toronto ON M5S 3G9 Phone: 416-978-6102 Fax: 416-978-4317

Internship Evaluation Form


Dear Internship Supervisor: To facilitate the professional development of our students, we ask you to fill out this performance evaluation. We encourage you to discuss the results of this evaluation with the student. It is important that the evaluation be completed by the student's immediate supervisor. Should you have questions, please email Prof. Chau ([email protected]). We appreciate your frank evaluation. Please return or fax the signed form by the end of the internship to the above address.

Student First Name

Student Last Name

Supervisor First Name

Supervisor Last Name

Internship Start Date

Internship End Date

Please CHECK the category which best describes the student's performance in each of these areas. 1. FULFILMENT OF INTERNSHIP OBJECTIVES (Please refer to objectives and deliverables set out at the beginning of the internship) All objectives adequately fulfilled Most objectives fulfilled Few objectives fulfilled Objectives not met Comments: 2. ACADEMIC PREPARATION OF THE STUDENTS Excellent Very good Average Below average Comments:
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3. INTEREST IN WORK /RESEARCH Very enthusiastic Generally interested Sometimes interested Little interest or enthusiasm Comments: 4. ABILITY TO LEARN Exceptional ability to learn new concepts or tasks very quickly Generally capable of learning new concepts or tasks within reasonable time frame Can learn with appropriate mentorship and guidance within reasonable time frame Requires more time to learn new concepts or tasks even with mentorship Comments: 5. INITIATIVE Consistant self-starter and always strives to add value Demonstrates some initiative on selected challenges Acts voluntarily only in routine matters Always waits to be told what to do next Comments: 6. INDEPENDENCE Requires minimal supervison, very independent Can usually work independently Works well under adequate supervision Requires constant mentorship or instruction Comments: 7. ORGANIZATION/PLANNING Very organized and always equipped with a plan of action Generally organized and usually plans ahead Occasionally not organized and unprepared for the tasks at hand Generally not organized and ill-prepared for the tasks at hand Comments: 8. QUALITY OF WORK/RESEARCH Very thorough. Outstanding attention to detail Usually thorough. Generally, good work with very few errors Work usually required review. satisfactory work, but may contain some errors Work usually completed in careless manner and constantly plagued with errors
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Comments: 9. ANALYTICAL/PROBLEM SOLVING SKILLS Always understands the problems at hand; regularly exercises critical thinking and systematic problem solving. Carefully evaluates and selects among alternatives and successfully solves problems with little assistance Generally understands the problems at hand; good analytically skills but may require assistance in solving problems Sometimes understands the problems at hand; analytical skills are satisfactory and usually requires assistance in solving problems Usually poorly understanding of the problems at hand; experiences difficulty in evaluating and selecting among alternatives; consistently gets stuck in the problem-solving process Comments: 10. DEPENDABILITY Completely dependable; worry-free Usually dependable Sometimes neglectful or careless Unreliable Comments: 11. ACCEPTANCE OF SUGGESTIONS AND CRITICISMS Takes prompt action in response to suggestions and feedback from supervisor Accepts suggestions and criticisms by supervisor and usually implements corrective behavior over time Reluctantly accepts suggestions and criticisms by supervisor; very little demonstrated effort to improve Resents suggestions and criticisms by supervisor; no demonstrated effort to improve Comments: 12. RELATIONS WITH OTHERS Works very well with others Work with others satisfactorily Has difficulty with some individuals General difficulty working with others Comments: 13. COMMUNICATION (with users, peers, co-workers and other health care providers) Excellent Good Satisfactory Needs improvement
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Comments:

14. ATTENDANCE AND PUNCTUALITY

Poor Attendance Punctuality

Fair

Satisfactory

Good

Excellent

Comments:

OVERALL PERFORMANCE
Outstanding - would not hesitate to rehire Very Good - would consider rehiring Average - would rehire with reservation Marginal - would not rehire Comments:

EVALUATED BY:

Supervsor Name (print)

Signature

Date

OVERALL SCORE (FOR OFFICE USE ONLY)

Internship:

One

Two

Three

COMMENTS FROM STUDENT (Please print)

Student Name (print)

Signature

Date

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