Sickness and absence record Sick or absence Date from: Date to: Total number of days Number of hours absent Signature sign-off mentor Placement area The above is a true and accurate record of my sickness/absence. The University has been informed of all episodes of sickness or absence to enable them to record this information on my student file. Signature of student: ___________________Print name: _______________ Date: ___/___/___ RECORD OF PLACMENT ATTENDANCE Year 2 Learning Period 1 Student’s Name ….......................................... Student has attended as follows: Hours Mentor Signature Placement Week 1 …..........hrs Week 2 …..........hrs Week 3 ……… hrs Week 4 ……… hrs The student has not attended the placement on the following occasions: Date(s) not attended Number of missed Number of hours made up outstanding at end of placement Total number of hours worked …....................Number of Nights worked (if any)……………… Mentor Print name………………………………………………. Mentor’s signature ……………………….................................Date ………………. I verify that the above student has worked 40% of the time within this placement with a sign off mentor on the mentor register. Mentor’s signature ……………………………………………... Date…………………………… Student’s signature………………………………………..…... Date………………………………
In the of sickness it is the student’s responsibility to inform the placement area and the University of Hull – Midwifery Programme Secretary Andrea Randerson, phone (01482) 464583. Module Team Verification Signature ……………………………… Date …………… RECORD OF PLACMENT ATTENDANCE Year 2 Learning Period 1 Student’s Name ….......................................... Student has attended as follows: Hours Mentor Signature Placement Week 1 …..........hrs Week 2 …..........hrs Week 3 ……… hrs Week 4 ……… hrs The student has not attended the placement on the following occasions: Date(s) not attended Number of hours missed Number of made up outstanding at end of placement Total number of hours worked …....................Number of Nights worked (if any)……………… Mentor Print name………………………………………………. Mentor’s signature ……………………….................................Date ………………. I verify that the above student has worked 40% of the time within this placement with a sign off mentor on the mentor register. Mentor’s signature ……………………………………………... Date…………………………… Student’s signature………………………………………..…... Date………………………………
In the event of sickness it is the student’s responsibility to inform the placement area and the University of Hull – Midwifery Programme Secretary Andrea Randerson, phone (01482) 464583. Module Team Verification Signature ……………………………… Date …………… Record of experience & feedback This section should be used to record the feedback/practice experience(s) outside the normal interview process of a student’s progress during the placement(s) e.g. A student may work with another member of the multi-professional team, who can provide feedback to the student A sign-off mentor can record the ongoing achievements of the student between the tripartite assessments A student/sign-off mentor/healthcare professional may have concerns with the placement and informs the liaison/link lecturer and an action plan then be negotiated. This must be used in a placement where the interim or final interview does not take place. If at any time issues are raised requiring further investigation, individual University processes should be adhered to. Date/ time Placement area Review of student’s progress/experience Action plan / review of action plan Outcome of review / comments