Fillable Radiologic Technology Clinical Progress Alert (Indian Hills Community College)

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Radiologic Technology Clinical Progress Alert (Indian Hills Community College)

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Clinical Progress Alert
Radiologic Technology Program
To:
From:
(Clinical Coordinator/Program Director) (Clinical Instructor)
Student: Date:
Please use this form to inform the Clinical Coordinator or Program Director of a potential problem that a student
in your clinical setting may have. Early detection of student problems is critical in helping the student find an
adequate solution to his/her situation.
Irregular Attendance
Declining quality of work
Declining quantity of work
Inability to complete competencies required
Poor motivation
Poor attitude toward work
Poor attitude toward co-workers/fellow students
Confidentiality issues
Safety issues
Lack of self-confidence
(Other)
Other clinical instructor comments:
Follow-up conference with student:
Student’s Signature:
Date:
Clinical Coordinators or Program Director’s Signature:
Date:
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Radiologic Technology Clinical Progress Alert (Indian Hills Community College)

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Completed 18 July 2020

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