Muskogee County EMS

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MCEMS Preceptor Evaluation Form

Student riders please complete this form for each shift. Muskogee County EMS is very intrested in YOUR opinion of us. We need your honest feedback as to how we can be better….for our patients, customers, students and employees. If you would like to personally talk to a supervisor, please call (918) 683-0130.

MCEMS PRECEPTOR EVALUATION FORM

Your Name:

Shift Date:

Shift Start:

Shift End:

Unit Number:

Name of Preceptor:

Introduced self and partner. Checked out unit with student and reviewed student status:

Excellent

Good

Fair

Below Average

Poor

Demonstrates a professional attitude towards the student:

Excellent

Good

Fair

Below Average

Poor

Provided opportunities to review skills, assists with performance weaknesses:

Excellent

Good

Fair

Below Average

Poor

Provides constructive feedback in a timely manner:

Excellent

Good

Fair

Below Average

Poor

Is supportive of the student, understands learning objectives, and is willing to discuss issues in a professional manner at the appropriate time:

Excellent

Good

Fair

Below Average

Poor

Ease and covenience of 3rd ride scheduling:

Excellent

Good

Fair

Below Average

Poor

What, if anything, could we do better or differently next time?

Would you consider Muskogee County EMS for future employment?

YES

Can you explain why?

If you would like for us to contact you regarding this form please include your phone number and / or email

Number to reach you at:

Your email address:

Email a copy to

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MUSKOGEE COUNTY EMS

MCEMS Preceptor Evaluation Form

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