ATTENTION EMPLOYERS: Completion of this survey is critical as results are provided to the educational program and used for program improvement and accreditation outcomes reporting. Your input and participation are truly appreciated!

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* 1. Date

Date

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* 2. Employee graduated from which university?

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* 3. Name of Company:

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* 4. Name of Evaluator:

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* 5. Title of Evaluator:

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* 6. Knowledge Base (Cognitive Domain)

  1-Poor 2-Below Average 3-Average 4-Good 5-Excellent
Knowledge of basic clinical practice:
Knowledge of professional practice and ethical conduct:
Knowledge of interdisciplinary practice and cooperative programming:
Knowledge of research application and interpretation:
Ability to interpret prescription for therapeutic exercise from referring parties:
Skills to analyze problems:
Skills to prioritize and define the goals and objectives of a problem:
Skills to generate creative and conceptual solutions to problems:
Oral communication skills needed to elicit information, negotiate, and present to others:
Writing skills appropriate to producing treatment reports, patient charting, and/or articles for publication:

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* 7. APPLIED DESIGN AND PRODUCTION SKILLS (Psychomotor Domain)
The employee had the ability to:

  1-Poor 2-Below Average 3-Average 4-Good 5-Excellent
Obtain oral medical history from client/caregiver:
Evaluate client fitness, including strength, endurance, power and flexibility:
Evaluate client cardiorespiratory fitness:
Evaluate client balance and mobility, including use of mobility aids:
Develop, in cooperation with client and caregiver, attainable goals and objectives for treatment:
Develop and implement appropriate therapeutic exercises to maximize client functional status:
Assess client progress toward goals and modify treatment program as needed:
Develop and instruct client/caregiver in home exercise program:

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* 8. BEHAVIORAL SKILLS (Affective Domain)
The employee:

  1-Poor 2-Below Average 3-Average 4-Good 5-Excellent
Communicates effectively with clients, caregiver, referring physicians, co-workers, supervisors, and vendors:
Work cooperatively with others on team projects:
Elicit client/caregiver needs through written and verbal communication:
Seek client/caregiver feedback at each stage of treatment and make modifications as needed:
Practice in a professional and ethical manner:
Comply with all documentation policies of the facility:

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* 9. Overall Preparedness (entry level)

  1-Strongly Disagree 2-Generally Disagree 3-Neutral (acceptable) 4-Generally Agree 5-Strongly Agree
Graduate is adequately prepared for an entry-level position:

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* 10. Identify the employee's strengths:

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* 11. Identify the employee's weaknesses:

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* 12. What suggestions do you have for improving the education of future graduates?

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