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Field Rotation Evaluation by the Paramedic Intern
General Information

Intern's EMT #:   
Intern's Last Name:   
Intern's First Name:   
Date of Shift:    
Clinical Site:
If Other, please specify:   
Preceptors Name:

Please consider each item separately and rate each item independently of all others.

Please do not skip any rating, if the statement does not apply, select "Not Applicable."

 Not ApplicableStrongly DisagreeGenerally DisagreeNeutral (Acceptable)
Generally AgreeStrongly Agree
The preceptors were helpful, interactive, and knowledgeable.
My preceptor had adequate experience to mentor and precept paramedic interns.
In my opinion, the specific agency offered sufficient skills to make my clinical rotations productive and worthwhile.
Preceptors encouraged my participation with patient assessment and care.
My preceptor enjoyed hosting a paramedic intern on his/her ambulance.
Preceptors offered constructive criticism when I made mistakes.
Paramedic - paramedic intern interaction at this site is adequate / good.
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Date:   


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