Fieldwork education is an integral part of the educational process in occupational therapy and assessing student competency at the end of fieldwork is important. The aim of this study was to design and conduct an Objective Structured Clinical Examination (OSCE) based on the Occupational Therapy Practice Framework (OTPF) for occupational therapy students on Level II fieldwork in Iran. A seven-station OSCE was designed and conducted with 13 students. Face and content validity of the exam scenarios and grading checklists was assessed via faculty review. The correlation between scores from each station and total OSCE scores were obtained to assess construct validity. Inter-rater reliability between two independent examiners at each OSCE station was determined. The participants' (including both students and examiners) reactions to and learning from the exam was assessed using a self-report questionnaire that included participants' attitudes, satisfaction, and emotional response to the OSCE. Finally, a focus group of 12 examiners was conducted to examine the strengths and weaknesses of the exam. It was ascertained that the OSCE had good and acceptable face, content, and construct validity as well as inter-examiner reliability. All students reported that the exam was stressful, and most students (n=8, 61%) and examiners (n=5, 42%) reported there was not enough time for each station. Strength and weaknesses of the exam as related to the exam condition, exam content, students, and examiners were reported. Based on the qualitative and quantitative analysis of the results, in order to use OSCE as a method of evaluating occupational therapy students, some changes should be applied.