Form G (Graduate Programs) Policy C-03Clinical Site/Preceptor Assessment by StudentsSemester*SpringSummerFallDate Preceptor Name* First Last Faculty Name* First Last Faculty Email* Name of Site*Clinical UnitStudent Name* First Last Course Number*Clinical TrackAcute CareAdultClinical Nurse LeaderFamilyMidwiferyNeonatalPediatricsPsych/Mental HealthInstructions: Use the drop down boxes to select your assessment for each statement. Space is provided next to each statement if you choose to add any comments.Clinical Site1. Number of clients is sufficient*YesNoN/AComments2. There are opportunities to follow up with clients and/or clinical problems.*YesNoN/AComments3. Lab report and x-ray are accessible.*YesNoN/AComments4. Staff are available to help.*YesNoN/AComments5. Community resources, other agencies, and professional disciplines are involved with clients.*YesNoN/ACommentsPreceptor(s)1. Assist in identifying goals and needs for experience.*YesNoN/AComments2. Considers student's limits according to status in program.*YesNoN/AComments3. Provides timely feedback.*YesNoN/AComments4. Provides rationale for own decisions.*YesNoN/AComments5. Reviews differntial diagnoses with student.*YesNoN/AComments6. Discusses alternative management plan.*YesNoN/ACommentsGeneral CommentsList ways this agency/individual provides quality clinical experience for students. RecommendationsList other areas in which this agency/individual could provide optimal student learning.