If you’ve landed on this article, you’re probably just about done with your OT program’s curriculum and are about to start preparing for your Level II fieldwork.
Hooray! You’ve made it so far and you are so close to the home stretch.
As you’ve likely been told, your Level II fieldwork will incorporate everything you’ve learned during your coursework in a real-life, hands-on OT setting.
Fieldwork really is an amazing yet challenging experience that will help shape you as an occupational therapist. You will be able to take your favorite interventions you observe or learn from the practicing OTs and add them to your “bag of tricks” as you go.
Your Level II fieldwork will fly by, and it may also feel like an eternity at times. You may have an awesome setting that you just “get” right away, or you may have the most challenging experience of your career, but both experiences will pay off in the end (I promise!).
Important Topics to Study Ahead of Time
First things first, you’ll want to brush up on the setting you’ll be working in. You may have an out of state assignment that you are moving for, so don’t forget to pack all of your phys-dys books for adults, your mental health books, and your pediatrics books for the setting you’re going to.
If you’re going to work in any rehab setting, really brush up on muscles, nerves, innervations, and dermatomes. This is all the tricky stuff from neuro and anatomy. Be sure to watch videos of Manual Muscle testing, goniometry, and transfers.
If you’re doing an inpatient rehab fieldwork, outcome measures can be tricky if you haven’t used them before. Historically this meant learning the FIM, but most post-acute settings, including IRFs, SNFs, and home health, now use Section GG of the CMS assessment for functional scoring. The terminology differs from what you learned in school, so it’s worth reviewing ahead of time. Ask your CI which system your site uses, since some facilities still use FIM data internally alongside Section GG reporting.
In pediatrics, you will want to reteach yourself all of the essentials like sensory integration, common pediatric conditions and developmental milestones.
Extremely Helpful Fieldwork Prep Resources
If you didn’t purchase Karen Sames’ book Documenting Occupational Therapy Practice in school, I highly recommend it as it covers everything from goal writing, evaluations, discharges, SOAP notes, and tons of skilled terminology. I used it constantly in both of my Level II’s and during my first few months of practice on my own before I really got the hang of note writing.
One other “resource” I used daily was my Kwik-Clips Occupational Therapy clipboard. 
It has MMT/goniometry scales, goal writing phrases, dermatomes, spinal cord injury levels, CVA effects, and more of the essentials that are really helpful to glance at when you’re on the move. I still use mine today in acute care when I need a quick refresher.
(Quick disclosure: These are Amazon affiliate links, meaning I may get a small commission at no cost to you if you purchase from my link.)
Living Expenses for Level II Fieldwork
Remember that your fieldwork will probably take up at least 40 hours a week, and you will be exhausted from all of the information your brain is taking in.
Work will be very difficult to try to juggle in addition to your clinicals. Level II fieldwork is typically full-time and unpaid, which is one of the profession’s genuine ongoing challenges. Plan ahead where you can:
- Check whether AOTA or your state OT association offers student scholarships
- Some sites, particularly in underserved areas or VA systems, offer stipends or housing assistance–worth asking about
- If you’re relocating, ask your fieldwork coordinator whether the program maintains a list of past students who found affordable housing near the site
- Budget conservatively in the semesters before fieldwork if you can
Working alongside a full-time fieldwork is genuinely difficult, and burning out mid-placement is its own risk. If you must work, weekend or low-cognitive-demand shifts tend to be more sustainable than weeknight hours.
Activity Analysis and Grading Up/Down
Before you start fieldwork, brush up on activity analysis and grading up/down. You will do this with every patient every day. Also read up about medical conditions, lab values, and all post surgical precautions.
A quick reminder that activity analysis and grading entails breaking down the specific patients’ deficits that make it hard for them to perform daily tasks. This could be things like left hemiplegia, decreased safety awareness, left neglect, poor standing tolerance, for example.
Then, you’ll brainstorm all of the activities that address each specific deficit and make it the “just right” challenge for the patient (ensuring the task is not too hard, not too easy).
I struggled with this during fieldwork and thankfully had an understanding CI to teach me, but you’ll earn extra bonus points having this in your skill set before you even start 🙂
Study the Code of Ethics
It also won’t hurt at all to read your state’s and AOTA’s Code of Ethics since you will be in this brand new experience and may have some very difficult standards for productivity.
I remember being surprised after my second week at one of my fieldworks reading in one of my textbooks that under Medicare you can’t bill for non-face to face time (I had no clue!).
So along with all of the other recommended things to brush up on, try to carve out a bit of extra time on ethics since your CI might not think to educate you on this right away.
Introduce Yourself to Your CI Before Your First Day
It’s always a good thing to start off on the right foot with your CI to see what you should prepare for, since they will devoting so much of their time for the next three months teaching you more than you thought possible.
Be sure to send your CI a formal introductory email if you can, at least a few weeks before you start. In this you can and should ask her or him where you need to show up, what time, what you should really focus studying in preparation along with your course notes.
Handle the Paperwork Early
Most sites require clearances that take longer than students expect. Start these as soon as you have your placement:
- Background check and fingerprinting
- Drug screening
- Immunization records (including TB testing, which may require a two-step process)
- CPR/BLS certification (check whether your site requires American Heart Association specifically, as some won’t accept Red Cross)
- HIPAA and site-specific onboarding modules
- Health insurance verification and liability insurance documentation
Some sites also require badge photos, parking registration, or EMR training modules before day one. Ask your CI or the site’s student coordinator what’s needed and when.
If Things Aren’t Going Well After You Start
Most occupational therapy fieldwork experiences go fine. Some don’t, and it’s worth knowing what to do if yours is one of them.
Speak up early. If you’re confused about expectations, struggling with a skill, or unclear on feedback, raise it in week two rather than week eight. CIs are generally far more concerned about a student who doesn’t ask than one who asks a lot.
Loop in your academic fieldwork coordinator. Your fieldwork coordinator is your advocate and has seen this before. If communication with your CI has broken down, if you feel uncomfortable, or if expectations seem unreasonable, contact them. Waiting until things are unsalvageable helps no one.
Ask for specifics. “You need to be more confident” isn’t actionable. “What would you want to see me do differently in tomorrow’s session?” is. Requesting concrete examples is a professional skill, not a complaint.
Struggling doesn’t mean you’re in the wrong profession! A difficult placement often reflects a mismatch in setting, supervision style, or timing. Many excellent OTs have had a rough Level II.
Lastly, BREATHE!
I know you have a million and one things to try to do before starting fieldwork but here’s the thing: If you’re feeling anxious about starting, remember that you are there to learn and you will be fine.
The first couple of weeks you will mostly just be observing the patients and soaking it all in before getting hands-on, so don’t forget to take notes of what interventions your CI does and tweak them if you like. Your CI will also learn from you and your fresh-out-of-school, brand new evidence-based research knowledge!
Take it one day at a time and enjoy it for what it is and you will very soon look back and think, “Wow, that was fast!”
If you’ve been having any concerns prior to starting your OT fieldwork, or if I’ve missed any important factors of pre-fieldwork prepping, please let me know in the comments below.
And best of luck!
This post was last updated on August 22, 2026.
