Benedictine University Dietetic Internship
Rotation:

Dietetic Intern Self-Evaluation Form

 

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Dietetic Intern's Name:

Date:

 

Site:

 

Directions: Please select the category that best describes your judgment of your performance for that category. The rating should be a comparison of current performance as it relates to the performance level needed as an entry-level dietitian. Dietetic Interns are required to supply narrative input in their own self-evaluations.

 

This Form is to be used by the dietetic intern to complete formative and summative self-evaluations during rotations. It is the RESPONSIBILITY of the DIETETIC INTERN to proactive plan and to dependably submit completed forms in a timely fashion. Evaluation is both of performance and assignments performed at the site and as part of the rotation.

  • Mid-point formative evaluations should be completed for rotations that are eight weeks or longer in length, and are to be submitted in week four of that rotation.
  • Summative evaluations should be completed for every rotation lasting five or more weeks in length, and are to be submitted on or before the Monday of the last week of that rotation.

 

Directions for completing the form:  TEST THIS FORM ON YOUR PRINTER FIRST to check the margins (otherwise “cut and paste” into a word document). This form should be completed by typing in the open text areas provided and making selections using the "drop boxes" (click on the "Select Rating" arrows for the choices, then click to highlight your selection), and then printing the completed form. Once the evaluation form is complete, be certain to sign and date the form. Submit a copy to the Dietetic Internship Director. Your site preceptor may request a copy (be proactive and ask).

 

Attendance

 

General Appearance

Number of days absent

 

Acceptable

Number of times tardy

 

Not Acceptable

 

Please refer to this Rating Scale in making your assessment on the following characteristics:

4

Superior (Distinguished) (+)

3

Above Average (Outstanding)

2

Average (Satisfactory)

1

Below Average (Needs Improvement)

0

Unacceptable (Unsatisfactory) (-)

 

Planning for assignments. (established goals and objectives, accepts responsibilities, anticipates unexpected developments, formulates plans that achieve desired result, organized, manages time efficiently)
Comments:

Decision Making (ability to recognize problems, ability to make sound decisions under stress, consistently exercises good judgment, looks at problems objectively)
Comments:

Job Knowledge (possesses amount of knowledge necessary to complete stated objectives, accuracy, observation to detail)
Comments:

Dependability (follows through with assignments, promptness)
Comments:

Initiative (ability to act promptly, willingness to take independent action, consistency in attaining goals).
Comments:

Resourcefulness (ability to readily determine alternative courses or plans of action in event of change, inventive, clever, creative).
Comments:

Adaptability (flexibility, attitude response to new assignments and change).
Comments:

Industriousness (diligence, effort)
Comments:

Enthusiasm
Comments:

Interpersonal Skills (ability to submit ideas and receive acceptance, tactful, considerate, cooperative, accepts criticism, sense of humor, professional manner).
Comments:

Verbal Communication (quality of oral presentation, ability to actively participate in discussions and meetings, ability to listen)
Comments:

Written Communication (quality of reports, ability to use written correspondence effectively, what types of techniques are used?)
Comments:

 

Dietetic Intern's Signature:

Date:

DI Director's Signature:

Date:

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