Field Work Evaluation Form:

Name of Coach/Administrator/Instructor Filling out this Form:

______________________________________________

Student Name: __________________________________

Attended: Collision/Contact Sports: Football W Soccer W Basketball

M Basketball Wrestling M Soccer

Limited Contact Sports: Baseball Softball Volleyball

Non-Contact Sports: M Golf W Golf Cross country Track Swimming M Tennis

W Tennis Field Events

Event: Game Practice Date of Event: ______________

Time Began:________Time Ended:__________Total Hours:____

Was the student on time for pre-game warm up? Yes No

Was the student dressed appropriately? (Appropriate professional attire: knee length shorts/slacks, collared shirts and close-toed shoes) Yes No

Did the Student act in an appropriate manner for a student athletic trainer during the event? Yes No

Did the student involve him/herself in any of the following activities?

Watering athletes Yes No

Injury prevention Yes No

Equipment/supply packing Yes No

Wound care Yes No

Injury Evaluation Yes No

Injury Management Yes No

Were there any injuries today? Yes No

Any Special Comments? ______________________________________________

__________________________________________________________________

Please fill this form out for the student, as he/she must turn it into me to get credit for his/her hours today.

The above is true and accurate to the best of my knowledge.

_________________________________ ____________

Administrator, Coach, Teacher Signature Date