Date: Session / Week No. Name of Student: Name of Educator: Placement Area: Learning outcome number Objective Resources Achieved/Not achieved PgDip/MSc Occupational Therapy WEEKLY OBJECTIVES AND SUPERVISION FORM (Practice placement educator and student should each retain a copy of this form) Date: Session / Week No. Name of Student: Name of Educator: Placement Area:
Comments: Strengths: Development needs: Learning outcome 9 Unable to describe the use of reasoning and problem-solving skills to determine appropriate actions. Able to describe the use of reasoning and problem-solving skills to determine appropriate actions. Comments: Strengths: Development needs: Learning outcome 10 Unable to demonstrate appropriate interventions under the supervision of their educator. Able to demonstrate appropriate interventions under the supervision of their educator.
Comments: Learning outcome 3 Able to demonstrate the need to practice safely and effectively within their scope of practice. Pass Refer Comments: Learning outcome 4 Able to demonstrate the ability to work in partnership with other staff, service users and carers. Pass Comments: Learning outcome 5 Able to demonstrate effective and appropriate communication skills including communication and information technologies. Pass Refer
Comments: Learning outcome 12 Able to discuss ways in planned activity may be modified to ensure effectiveness. Pass Refer Comments: Learning outcome 13 Able to demonstrate the ability to reflect on and review practice. Pass Refer Comments: Learning outcome 14 Able to define the key concepts of the bodies of knowledge which are relevant to the profession practice area. Pass Refer
Signature of student……………………………………………………………...Date………………. Signature of Academic Practice Placement Organiser ATTENDANCE SHEET PRE-REG NURSING, MIDWIFERY, RADIOGRAPHY, PHYSIOTHERAPY, OCCUPATIONAL THERAPY & DENTAL CERT HE Surname ……………………………………………………………………………………… Forename …………….………………………………………….. Cohort ……………. Month ……………… Year ……….……… Date Shifts Total Hours Worked/ Sick Code Clinician / Mentor Sign to Verify Shift worked with mentor / supervisor? () (for Nursing, Midwifery, Dental Cert HE only) Code Time Started Time Finished 1 ND – Night Duty DO – Day Off AL – Annual Leave S – Sick A – Absent U – University / Theory P – Placement Hours Relate to placements only and should include the time started and finished. Please note that you must subtract your meal break from the total hours worked column. Hours per week Nursing 37.5 Midwifery 3yr 35 Midwifery 78wk 37.5 Radiography 28 Physiotherapy 36 Occ Therapy 37.5 MSc Rehab 37.5 Dental 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Student Signature ……………………………………………………………………………………. Date …………………………………………………….
Practice Mentor / Educator / Supervisor’s Signature ……………………………………..................................................…………………............... Date ……………………………………………………. The form should be signed by the student and countersigned by the Practice Mentor / Educator / Site Co-ordinator each In addition they will be checked by the Academic Mentor at the end of the tripartite meeting (nursing / midwifery) / at the end of the placement (OT) / at the final bipartite meeting (DR). ATTENDANCE SHEET PRE-REG NURSING, MIDWIFERY, RADIOGRAPHY, PHYSIOTHERAPY, OCCUPATIONAL THERAPY & DENTAL CERT HE Surname ……………………………………………………………………………………… Forename …………….………………………………………….. Cohort ……………. Month ……………… Year ……….……… Date Shifts Total Hours Worked/ Sick Code Clinician / Mentor Sign to Verify Shift worked with mentor / supervisor? () (for Nursing, Midwifery, Dental Cert HE only) Code Time Started Time Finished 1 ND – Night Duty DO – Day Off AL – Annual S – Sick A – Absent U – University / Theory P – Placement Hours Relate to placements only and should include the time started and finished. Please note that you must subtract your meal break from the total hours worked column. Hours per week Nursing 37.5 Midwifery 3yr 35 Midwifery 78wk 37.5 Radiography 28 Physiotherapy 36 Occ Therapy 37.5 MSc Rehab 37.5 Dental 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31