Health Care Assistant Program Learning Outcomes Verification
This form confirms that the student identified below has completed the required practice education placements and placement hours for the HCA Practice Education program segment and has been deemed by their instructor as having met the required program learning outcomes outlined in the HCA Program Provincial Curriculum Guide 2015, p. 18.
Student Name: (please print)
Multi-level/complex care placement site name(s):
Date(s): Number of hours completed:
Name of instructor(s):
Assisted living/home support/group home placement site name(s):
Date(s): Number of hours completed:
Name of instructor(s):
Directions: Please indicate whether or not the student has met (been able to demonstrate) the following learning outcomes in the clinical setting and sign and date the bottom of the form.
1. Provide person-centred care and assistance that recognizes and respects the uniqueness of each individual client. | Met | Not Met |
Examples and comments:
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2. Use an informed, problem-solving approach to provide care and assistance that promotes the physical, psychological, social, cognitive, and/or spiritual well-being of clients and families. |
Met | Not Met |
Examples and comments:
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3. Provide care and assistance for clients experiencing complex health challenges. | Met | Not Met |
Examples and comments:
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4. Provide care and assistance for clients experiencing cognitive and/or mental health challenges. | Met | Not Met |
Examples and comments:
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5. Interact with other members of the health care team in ways that contribute to effective working relationships and the achievement of goals. | Met | Not Met |
Examples and comments:
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6. Communicates clearly, accurately, and in sensitive ways with clients and families within a variety of contexts. | Met | Not Met |
Examples and comments:
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7. Provides personal care and assistance in a safe, organized, and competent manner. | Met | Not Met |
Examples and comments:
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8. Recognizes and responds to own self-development, learning, and health enhancement needs. | Met | Not Met |
Examples and comments:
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9. Performs the care provider role in a reflective, responsible, accountable, and professional and ethical manner. | Met | Not Met |
Examples and comments:
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Instructor Name Instructor Signature Date
Instructor Name Instructor Signature Date
Student Name Student Signature Date
Download Health Care Assistant Program Learning Outcomes Verification [PDF].
Note: This sample tool has been included to align with Suggested Course Assessments 3 and 5 included in the Practice Experience in Multi-Level and/or Complex Care course and Suggested Course Assessment 2 included in the Practice Experience in Home Support, Assisted Living, and/or Group Home course. It could be further adapted for use as a self-assessment by the student.