Personal casework i) Personal casework and (minimum 115 hours). Direct (documented) ii) Direct supervision supervision b) Maximum 60 hours (i.e. approx. 50% of File Review (inc. 115 hours) face-to-face) c) Maximum 115 hours Delivery of external training (CPD- accredited) d) Maximum 115 hours Documented research / production of publications e) Maximum 115 hours Other supervision TOTAL Minimum 350 hours 5. Declaration This Supervisor was and continues to be employed by the organisation named at 1 above as at the date of completion of this form. Tick box to confirm As a person with powers of representation, decision or control of the organisation named at 1 above, I verify the information provided in this form and vouch that it is accurate. Name: Role: (e.g. Partner, Director, Trustee) Dated:
Personal casework and Direct (documented) supervision i) Personal casework (minimum 115 hours). ii) Direct supervision b) File Review (inc. face-to-face) Maximum 60 hours (i.e. approx. 50% of 115 hours) c) Delivery of external training (CPD- accredited) Maximum 115 hours d) Documented research / production of publications Maximum 115 hours e) Other supervision Maximum 115 hours TOTAL Minimum 350 hours 5. Declaration This Supervisor was and continues to be employed by the organisation named at 1 above as at the date of completion of this form. Tick box to confirm As a person with powers of representation, decision or control of the organisation named at 1 above, I verify the information provided in this form and vouch that it is accurate. Name: Role: (e.g. Partner, Director, Trustee) Dated:
clinical-negligence-supervisor-declaration.docx