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The following questions are rated 1-4 with 1 being 'completely' and 4 'being not at all'.

>Date of assessment
2nd March 2010

>Profession
Emergency Care Practitioner

>Name and contact details
xxxxxxxxxxxxxxxxxxxxxxxxxx

>Did the student introduce themselves fully?
Please tick a single response.
X    1
2
3
4

>Did the student ensure that the service user could refuse to consent?
Please tick a single response.
X    1
2
3
4

>Did it appear that the student made the service user feel at ease?
Please tick a single response.
X    1
2
3
4

>Did the student clearly explain the course of action taking into account the individual needs of the service user?
Please tick a single response.
1
X     2
3
4

>Are you from the same profession as the colleague you are assessing?
Please tick a single response.
Yes
X    No

>Considering the assessment the student has just completed, do you think at this stage in their training they would be able to repeat this aspect of practice?
Please tick a single response.
Yes in most situations including under pressure
X    Yes in similar situations with minimal supervision
Yes in similar situations under close supervision
Only if it would be harmful to a service user not to
No

>Would you like to make any further comments on the student's overall performance?
He was very professional, I think the patient might have welcomed further explanation, but seemed quite happy.