Capstone Paramedic Course Final Evaluation

Student Name(Required)

Preceptor Name(Required)

Preceptor Email(Required)

Enter Email Confirm Email

Date of Evaluation(Required)

Clinical Site(Required)

Instructions

This evaluation form is to be completed by the capstone preceptor on one of the last three days of the student’s clinicals. The preceptor will evaluate the student’s readiness to graduate and move on to the next level based on their ability to complete calls independently and their affective behavior.

Each criterion should be scored on a scale from 1 to 4, with 4 being the highest. The student must achieve a score of 75% or higher to pass the course.

Evaluation Key:

Excellent (4): Performs at a level significantly above expectations
Satisfactory (3): Performs at the expected level
Needs Improvement (2): Performs below expectations but shows potential for improvement
Unsatisfactory (1): Performs significantly below expectations and requires substantial improvement

Assessment & Management: Scene Size-Up and Safety

Evaluates hazards and ensures scene safety(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Determines the number of patients and mechanism of injury/nature of illness(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Assessment & Management: Primary Assessment

Conducts an initial assessment(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Identifies life-threatening conditions(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Assessment & Management: Secondary Assessment

Performs a thorough secondary assessment(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Uses appropriate diagnostic tools and techniques(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Assessment & Management: Management Plan

Develops an appropriate treatment plan(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Executes treatment effectively(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Reassesses patient and modifies treatment as needed(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Clinical Procedures

Performs procedures accurately and safely(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Demonstrates proficiency in medication administration(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Manages equipment and technology effectively(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Professionalism and Ethics

Demonstrates professional behavior and appearance(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Adheres to ethical guidelines and patient confidentiality(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Communication

Communicates effectively with patients, families, and team members(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Provides clear and concise handoffs to receiving personnel(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Team Collaboration

Communicates effectively with patients, families, and team members(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Demonstrates leadership skills when necessary(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Emotional Stability and Stress Management

Maintains composure in high-stress situations(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Demonstrates resilience and adaptability(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Independence

Completes calls with minimal to no assistance from preceptor(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Shows readiness to handle paramedic responsibilites independently(Required)

Excellent	Satisfactory	Needs Improvement	Unsatisfactory

Final Recommendation(Required)

Yes

No

Do you recommend this student for graduation and progression to the next level?

Comments

Preceptor Signature(Required)

Date(Required)