UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE swuientsNane: — Shesss, Nehdres vate L/Dlel 1 comets Ot ap mee mee) eee ees ee CUT Number of hours worked on unit:_[)COO~Cenwe /KOS CLINICAL PRECEPTOR: ‘Above Aveysge Average Below Average = NIA Motivation to Leara cp | 6 Gg Patent Assessment Sills oe o Q o Docu q 8 4 a cementation a Professionalism ice oO a Comment: Showy) wads Vol to leon and be hourdlon Wt tps fs vr ep moped Sites and Priessional.Shdwn wil agteat Nurse! ue Very (Please Print) Preceptor Signature: a STUDENT EVALUATION OF PRECEPTOR: CCheckallthatapply _—AboveAvesage Average Below Average Knowledgeable a a Encouraged leraing Supportive oa Acts as roe mods! Ee Professionalism ooo oOoo0o00: Comments: CLINICAL FACULTY: Agree/Disagree with evaluations. Comments (including preceptor feedback): tinea Faculty Signatu Cc ‘Student Signature Revised May 2012UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE, swudenvsname: Shaws Helene vate 2f20 = r) Cone TE HSEN semester 3 Assigned unit: . = 2 neweascien Namberof hours worked on unit:_ 7 SICA CLINICAL PRECEPTOR: ‘Above Average Average ‘Below Average NA Motivation to Learn o a Patient sessment g g sul q q a satety Og g Documentation G a o Profesional 5 qo ded 46 Leow Comments Ogee k Ddsrk’ \Q ae wolnae & \ 4 Rev GvoeaMong Qnd& asrea ol Pew rong Rea ao +! Preceptor Name: CWPAA “OAS EVE (Please Print) at ~ a Preceptor Signature: AN STUDENT EVALUATION OF PRECEPTOR: ‘Check all that apply Above Average Average “Below Average Knowledgeable oa Encouraged learning. oa Supportive a ‘Acts as role model a Professionalism Oooo! oooo0: ‘Comments: CLINICAL FACULTY: Agree/Disagree with evaluations, cor including preceptor feed! Gud wens Somesrese | Always Honvated Clinical Faculty Signature ‘Student Signature Revised May 2012UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE student's Name: Shy paiva th aces her pate: \0|2 2015, course TEHSBA_semester_3~ Assigned units S24 Number of hours worked on unit: OL30~/IOD CLINICAL PRECEPTOR: Aboveyefage Average Below Average NIA, ‘Motivation to Learn g Q Patient Assessment oO Qa g Skills o o o Safety Q Oo Documentation Q Q o Professionalism oO QO comment: Shr Pal pink froasant the Arnelle, work |- ae =o fe a ry, Strsta Preceptor Name: ort f havin & fees (Pl Print) 5 . 7 Preceptar Signature Y "BNA LQ oaks a Heo te dest An Kin DY x pebicng STUDENT EVALUATION OF PRECEPTOR: Ank piby waly persue Check alates Avoesprace —Averge Eon Average rR that Wael Encore arg Zz ‘Acts as role model a Professionalism Comments: herby’ ba di fled. Sronk growth! ooo OOo000: CLINICAL FACULTY: Agree/Disagree with evaluations. Comments (including preceptor feedback): Clinical Faculty Signature { Student Signature Revised May 2012UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE setmterone Yona Holger» pea olf, coure 44CPL semester SY asignedt onte_po9: 2 Number of hours worked on unit: ge Average ‘Below Average NA a a A a o Patent Asesoment stil wy a aq a santy g g me & 6 § so Professionalism Bh Aton oi incann Comment: Wekve | h+ ‘out ores tn waa wntbgcmc) Gee Good As wenner, Bo u Sncersshl Preceptor Name: Lugh n Kiva, eed, Preceptor Signature: AMWrn bow Ty sTUp} JON OF PRECEPTOR: : ENT EVALUATI Me ek a” ne ee Petia. fatale a adinistrc pean, Soon nese peecea ooo ooo00: Comments: (CLINICAL FACULTY: Agree/Disagree with evaluations, Comments (including preceptor feedback): snamsmene fp Revised May 2012UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE Students Name: SAI He,ekduev Date: Alte course AUGPL semester 4 nines wate AL Number ot ours worked on ante CSO 1/43D CLINICAL PRECEPTOR: ‘Above Aveygge Average Below Average NA ‘Motivation to Learn a gq Patient Assessment uw q Qa Skills we a gq a poe cy 8 a o Documentation Professionalism a a a ' Comments: Shgutns Lda, Auuoane + Utena aii, anced fe ese Pe ORS eet drewennd, Precept Name: -Viconind Soknsem Bund (Please Print) Preceptor Signature: STUDENT EVALUATION OF PRECEPTOR: Check all that apply Above Ayprage —Avernge Below Average ‘Knowledgeable a Encouraged learning ‘Supportive ‘Acts as role model Professionalism at ooo Oooo: ‘Comments: CLINICAL FACULTY: Agree/Disagree with evaluations. ‘Comments (including preceptor feedback): Clinical Faculty Signature Student Signature Revised May 2012UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE students Name:_ Ghar pue:__[d/22)20° creat Ga areas Ga ee Number of hours worked on units OGZO-75/ CLINICAL PRECEPTOR: ‘Above Wvgrage ‘Average Below Average NIA ‘Motivation to Learn g a Patient Assessment a o Skills a Q a Safety a a Documentation g a [a] Professionalism oa a Comments: Ih Wis A Plea pe Nene Shy Wo & jmtepher, RKLE Ph ehpethian, No wm Shook. eee ie Week dow Preceptor Name: Kay lee, 2” rbot / (Please Print) , Preceptor Signature: Progam C By ‘STUDENT EVALUATION OF PRECEPTOR: Cheek all that apply. Above Average Average Below Average Knowledgeable Encouraged learning Supportive Acts as role model Professionalism oo0000; ooo000: Comments: CLINICAL FACULTY: Agree/Disagree with evaluations, ‘Comments (including preceptor feedback): cs na sonnel lskttd dou? ‘Student Signature Revised May 2012UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE Student's Name: Msg Hebbavev pae:__ 2p feo (5 course TYCPCR semester_4/% Assigned unit: PTCLU ‘Number of hours worked on unit: (630-[6CD CLINICAL PRECEPTOR: ‘Above Average Average Below Average NIA ‘Motivation to Learn g ia Patient Assessment i g sue q A o tty Documentation g g w Protestinalsn a a ‘Comments: Preceptor Name: Julia Proudfoot, RN (Please Print) n, Preceptor Signature: 1 RN STUDENT EVALUATION OF PRECEPTOR: Checkallthat apply Above Average Average Below Average ‘Knowledgeable cs ol eI Encouraged tearnin supportive x q o ‘Adis stole model a Oo og Professionalism o o Comments cuINIcAL FAcuL! ‘Agree/Disagree with evaluations. ‘Comments (including preceptor feedbact Clinical Faculty Signatur ‘Student Signature Revised May 2012UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE swientsNane: Showa febkawe — vax_S/i ros course 4QG7/ _ ‘Semester. am Assigned unit: q - in owl Number of hours worked on wits 82 OG30—/70 CLINICAL PRECEPTOR: ‘Above Avesage Average Below Average NA Motivation to Learn a Patient Assessment ee 0 Qo Skills a 8 gq a Safety Documentation 6 og og a Professionalism a a a ‘Comments: Preceptor Name: Dy one Cagle S ka (Please Print) Preceptor Signature: STUDENT EVALUATION OF PRECEPTOR: Check allthat apply Above Ayerage Average Blow Average Knowledgeable a oO ‘Encouraged learning a ‘Supportive a a ‘Acts as role model oO q Professionalism x o o Comments: CLINICAL FACULTY: Agree/Disagree with evaluations. ‘Comments (including preceptor feedback): Clinical Faculty Signature Student Signature_f AAP Revised May 2012 YUNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE sudewsnane hear fekbave? vue 3/26/20 16 conrse_GYLHL semester! assigned units JD Number of hours worked on unit: (S7O—| FOS cuntcaL-raecerTon: ‘Above Average Average ‘Below Average NIA ‘Motivation to Learn Patient Assessment g Skills Q Safety Q QO oO oo Documentation Professionalism > ooo0000 Comments: Preceptor Name:_()04U( Ci fi Quon. (Please Print) Preceptor Signature: __( g— ‘sTup) ION OF PRECEPTOR: ‘Check all that apply Above Svetfige Average Below Average ‘Knowledgeable Encouraged learning Supportive Acts as role model 5 Professionalism ooo on000: CLINICAL FACULTY: Agree/Disagree with evaluations, Com (including preceptor. Clinical Faculty Signat ‘Student Signature Revised May 2012UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING DAILY STUDENT ANECDOTAL NOTE, student's Name: Leas Helcheasers Date: Ysfeon, course YCAC_ semester FP _psigna ate SA Number of hours worked on unit: POO CLINICAL PRECEPTOR: ‘Above Average Average Below Average N/A ‘Motivation to Learn Ra) Q Q Patient Assessment si gq gq gq Skills Y Q Q a Safety Q Oo Documentation NH Q Q QO Professionalism No a Oo Comments; Preceptor Name: —— (Please Print) Preceptor Signatures STUDENT EVALUATION OF PRECEPTOI ‘Check all that apply Above Average Average alow Average Knowledgerbie oa Encouraged learning 4 oa Sapportive oa Acts a8 role model og Professionalism a oo0000: Comments: CLINICAL FACULT' Agree/Disagree with evaluations, Comments (including preceptor feedback): can ry semen, gull ob u #v Student Signature Revised May 2012