Fall 2021 - Clinical Site Evaluation Form

Thank you for completing this evaluation focused on the clinical site where you supervised students this past semester. This evaluation is important for optimal student learning as well as accreditation.

Date Date / MM / DD YYYY
Name Name First Last
Health Care Institution (Facility where this clinical rotation takes place):
Unit/Floor (please clarify facility if "other" was chosen in question above)
Population served (ie; med/surg, maternity, critical care, peds, psych, etc):

Please answer the following questions regarding this clinical unit:
	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Is this site appropriate for students?	Is this site appropriate for students?Strongly Agree	Is this site appropriate for students?Agree	Is this site appropriate for students?Neutral	Is this site appropriate for students?Disagree	Is this site appropriate for students?Strongly Disagree
Can the students meet the clinical objectives for this experience on this unit?	Can the students meet the clinical objectives for this experience on this unit?Strongly Agree	Can the students meet the clinical objectives for this experience on this unit?Agree	Can the students meet the clinical objectives for this experience on this unit?Neutral	Can the students meet the clinical objectives for this experience on this unit?Disagree	Can the students meet the clinical objectives for this experience on this unit?Strongly Disagree
Are students treated with respect for the health care team on this unit?	Are students treated with respect for the health care team on this unit?Strongly Agree	Are students treated with respect for the health care team on this unit?Agree	Are students treated with respect for the health care team on this unit?Neutral	Are students treated with respect for the health care team on this unit?Disagree	Are students treated with respect for the health care team on this unit?Strongly Disagree
Are students able to participate as part of the health care team on this unit?	Are students able to participate as part of the health care team on this unit?Strongly Agree	Are students able to participate as part of the health care team on this unit?Agree	Are students able to participate as part of the health care team on this unit?Neutral	Are students able to participate as part of the health care team on this unit?Disagree	Are students able to participate as part of the health care team on this unit?Strongly Disagree

What are the best aspects of this unit for students?
What could be improved about this clinical experience for students?
In your opinion, should we continue to use this clinical unit for our students?

In your opinion, should we continue to use this clinical unit for our students? Yes No