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MATRIX
NUMBER
2. Sign the Log Sheet only if you are satisfied with the students performance.
HOSPITAL
3. Add the marks at the end of the Clinical Placement and document the mark
NAME OF accordingly.
CLINICAL
PRECEPTOR
DATE
Please tick 1 6 Rating of: 1=Poor; 2=Fair; 3=Average; 4=Satisfactory; 5=Good; 6=Excellent
AIMS
OBJECTIVES
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KPJUC/SOHS(PHY)/EPO/ 02(01)
Target (10
1 2 3 4 5 6 4.KNOWLEDGE ON COMPANYS CORPORATE VALUES Marks)
1.PERSONAL APPEARANCE
T
1.1 Neat and Tidy
O
1.2 Always reflects Positive T
A CLINICAL PRECEPTORS COMMENT :
Personality
2.PERSONALITY L
2.1 Communication Skills (90
Marks)
2.2 Interpersonal relationship with staff
2.3 Interpersonal relationship with
patients
2.4 Commitment
2.5 Leadership
2.6 Punctuality
2.8 Courtesy
Signature of Student : ______________________
2.9 Empathy
3.OBSERVATIONAL SKILLS
Signature of Clinical Preceptor : ______________________
3.1 Ability to Identify relevant
information
3.2 Ability to relate theoretical Date : ______________________
knowledge
the Clinical Condition observed
3.3 Initiative in Work and Learning
TOTAL
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KPJUC/SOHS(PHY)/EPO/ 02(01)