Signed Preceptor Name of Preceptee Name of Preceptor w Date of interim review Today’s date Approximate Today’s date + 3 e date for final months i review v GOAL PROGRESS EVIDENCE SO FAR e R p i h s r o t p e c e r P m Action plan to complete goals if needed: consider line manager / link Clinical Educator i involvement if needed r e t n I Signed Preceptee
Signed Preceptor I n t e r i m P r e c e p t o r s h i p R e v i e w Name of Preceptee Name of Preceptor Date of interim review Today’s date Approximate date for final review Today’s date + 3 months GOAL PROGRESS EVIDENCE SO FAR Action plan to complete goals if needed: consider line manager / link Clinical Educator involvement if needed Signed Preceptee