RasGuides: *School of Health Sciences*: Practicum Forms

Practicum Forms

Practicum Case Study Form
Practicum Timesheet
Practicum Experience Record (Case Log)
Professional Behavior Checklist
Student Weekly Objectives 1st Rotation
Student Weekly Objectives 2nd Rotation
Surgical Technologist Practicum Objectives

Quarterly Forms

End of Quarter Evaluation
Student Self Evaluation
Student Evaluation of Clinical Site and Preceptors

Student Evaluations

Student Evaluation Daily Form
Student Weekly Goal Sheet

Additional Campus Forms

The following forms are used regionally for specific clinical practicum site requirements. Please contact your Program/Clinical Coordinator prior to the use of any of these forms.

First Case of Day
Practicum Case Tracking Worksheet - BP
Sterile Processing Student Performance Evaluation-RJ

For Faculty Use

Comprehensive Evaluation of Practicum Student
Student Evaluation by Preceptor

Immunization Medical Contraindication Accommodation:

Immunization Medical Contraindication Accommodation Request Form
Immunization Religious Exemption Request Form for Students
Student Medical Declination Form (Florida Students ONLY)
Student Religious Declination Form (Florida Students ONLY)