Preceptor evaluation form 2026

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  1. Click ‘Get Form’ to open the preceptor evaluation form in the editor.
  2. Begin by entering your name in the 'Intern Name' field, followed by your preceptor's name and license number.
  3. Fill in the 'Paramedic Program' and the dates for when your internship began and ended.
  4. For each rating question, select your response using the provided scale from 'Strongly Agree' to 'Strongly Disagree'.
  5. In the 'Overall Ratings' section, rate your preceptor and various components of the course using the scale from 'Excellent' to 'Very Poor'.
  6. Use additional pages if necessary to provide comments for any ratings that are below expectations.
  7. Finally, sign and date the form at the bottom before submitting it to the San Joaquin County EMS Agency.

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2012 4.8 Satisfied (198 Votes)
2011 4 Satisfied (24 Votes)
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The Ulrich Precepting Model identified 7 roles of preceptors: role model, teacher/coach, facilitator, protector, socialization agent, leader/influencer, and evaluator (Figure 1).
has a great work ethic and performed exceptionally well during this rotation. S/he is attentive, on time, and respectful. This was a great rotation for this student and we thoroughly enjoyed having her/him on rotation.
Three key competencies shared across all studies were facilitating teaching, being a role model and evaluating students performance.
In this step, react to what the learner has observed and give your positive and corrective feedback. The third step is to ask the learner their understanding of your feedback, whether it was constructive, and to develop a plan to monitor the learners improvement in the future.
How do you write a performance evaluation? Identify core competencies. Choose a rating scale. Set an evaluation cycle. Prepare a list of questions. Share questions in advance. Have the conversation. Create a goal-setting framework. Be open to feedback.

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