DOMAIN FOUR RATING GOOD PASS BORDERLINE FAIL PASS (Based on items 26-29) COMMENTS Item Yes - Yes - No - No Unable – exceeded expected somewhat far below Tick most appropriate column for each item to Rate below 30 Does the trainee clearly explain his/her role? 31 Does the trainee provide a framework for the session? 32 Does the trainee observe appropriate timekeeping? Other (please name) DOMAIN FIVE RATING GOOD PASS BORDERLINE FAIL PASS (Based on items 30-32) COMMENTS GENERAL COMMENTS (optional)
DOMAIN FOUR RATING (Based on items 26-29) GOOD PASS PASS BORDERLINE FAIL COMMENTS Item Tick most appropriate column for each item Yes - exceeded Yes - expected No - somewhat below No – far below Unable to Rate 30 Does the trainee clearly explain his/her role? 31 Does the trainee provide a framework for the session? 32 Does the trainee observe appropriate timekeeping? Other (please name) DOMAIN FIVE RATING (Based on items 30-32) GOOD PASS PASS BORDERLINE FAIL COMMENTS GENERAL COMMENTS (optional)
Revised_CSA-RF.docx