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Alumni& Internship Unit Internship Evaluation form

Department of Clinical Laboratory Sciences

Intern: Period: 1

st

2

nd

Hospital: From: / / /

Department: To: / / /

Evaluation

Performance Marks

Positive Qualities

Attendance 10 Choose qualities that best describe the intern:

Behavior 10 Interesting Knowledgeable Professional Communicative

Knowledge 10 Organized Skilled Responsible Cooperative

Safety/Quality 10 Punctual Willing to learn Motivated Hard worker

Communication Skills 10

Comments/ Recommendations

Assigned work Completion 10 Instrument Usage 10 Time Management 10 Results Interpretation 10 Educational Activity 10

Total 100%

Approved Leaves/ Days Official Emergency Other Total days

Name Dated

Signature

Official Stamp

Please send in Signed& Sealed envelope.

Intern:

Supervisor:

Internship coordinator:

For College Use

Approved Not approved

Alumni& Internship Unit Supervisor:

Referensi

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