Sickness and absence record Sick or Date from: Date to: Total Number of Signature Placement absence number of hours sign-off area days absent mentor 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 Number of Number of hours outstanding at end of placement attended missed made up Total number of hours worked of Nights worked (if any)……………… …....................Number 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………………………………
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………………………………
midwifery-practice-module-3-practice-assessment-document.docx