Student Apprenticeship Evaluation Form
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1STUDENT APPRENTICESHIP EVALUATION FORM
HEALTH
Apprenticeship Student Trainee:_________________
Work site:___________________
Mentor Name:(please print)_____________________
Phone Number:______________
RATING:
3 = Able to perform entry-level skills. Has performed job during training program; limited
addition training may be required
2 = Has performed job during training program; additional training is required to develop
entry-level skills.
1 = Is familiar with process, but is unable to perform job with entry-level skill.
Work Habits
Attendance/Punctuality
3
2
1
0
Takes suggestions
3
2
1
0
Follows company policies 3
2
1
0
Keeps on task
3
2
1
0
Suitability of dress
3
2
1
0
Gets along with others
3
2
1
0
Hygiene/Grooming
3
2
1
0
Quality of work
3
2
1
0
Communication
3
2
1
0
Quantity of work
3
2
1
0
Interest in work
3
2
1
0
Maintains confidentiality
3
2
1
0
Initiative
3
2
1
0
Customer service
3
2
1
0
Keeps accurate records
3
2
1
0
Patient contact
3
2
1
0
Potential for success
3
2
1
0
Asks for help
3
2
1
0
Shows desire to learn
3
2
1
0
Respectful to coworkers
3
2
1
0
Follows instructions
3
2
1
0
Safety habits
3
2
1
0
TOTAL POINTS:__________
GENERAL COMMENTS:___________________________________________________
GENERAL RATING OF STUDENT EMPLOYEE
:
(Please circle the most appropriate letter grade)
Excellent
Good
Average
Unsatisfactory
Failing
66-62
61-57
57-53
52-48
47 or below
A+ A A-
B+ B B-
C+ C C-
D+ D D-
F
Mentor Signature:_________________________________
Date:_________________
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