______________________________ ___________________________ Trainee Name Date Training Director Date Trainee’s comments (Feel free to use additional pages): All supervisors/ faculty with responsibilities or actions described in the above competency remediation plan agree to participate in the plan as outlined above. Please sign and date below to indicate your agreement with the plan. Competency Remediation Plan Continued SUMMATIVE EVALUATION OF REMEDIATION Follow-up Meeting(s): Date (s): In Attendance: Competency Expectations Outcomes Next Steps Next Domain/ for Acceptable Related to (e.g., Evaluation Essential Performance Expected remediation Date (if Components Benchmarks concluded, needed) (met, partially remediation met, not met) continued and
______________________________ ___________________________ Trainee Name Date Training Director Date Trainee’s comments (Feel free to use additional pages): All supervisors/ faculty with responsibilities or actions described in the above competency remediation plan agree to participate in the plan as outlined above. Please sign and date below to indicate your agreement with the plan. Competency Remediation Plan Continued SUMMATIVE EVALUATION OF REMEDIATION Follow-up Meeting(s): Date (s): In Attendance: Competency Domain/ Essential Components Expectations for Acceptable Performance Outcomes Related to Expected Benchmarks (met, partially met, not met) Next Steps (e.g., remediation concluded, remediation continued and Next Evaluation Date (if needed)
cpsy_handbook_14_15.docx