Student Signature: Print name…………………………………..Date……………… …………………………..………………………… Liaison / link lecturer (If applicable) Signature: Print name…………………………………..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 would 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 Feedback on student’s progress/experience Action plan / review of action plan Outcome of review / comments Supervisor/ mentor / sign-off mentor Signature: Print name…………………………………..Date……………… …………………………..………………………… Student Signature: name…………………………………..Date……………… …………………………..………………………… Liaison / link lecturer (If applicable)
Student Signature: …………………………..………………………… Print name…………………………………..Date……………… Liaison / link lecturer (If applicable) Signature: …………………………..………………………… Print name…………………………………..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 would 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 Feedback on student’s progress/experience Action plan / review of action plan Outcome of review / comments Supervisor/ mentor / sign-off mentor Signature: …………………………..………………………… Print name…………………………………..Date……………… Student Signature: …………………………..………………………… name…………………………………..Date……………… Liaison / link lecturer (If applicable)
midwifery-practice-module-4-practice-assessment-document.docx