GMC Item Applicant’s Details Domain 1.5 Applicant’s contact email address GI 1.6 Applicant’s mobile number (optional) GI 1.7 Date joined practice (minimum 1 GI year) 1.8 Please list your professional qualifications GI 1.9 Summary of clinical supervisor related CPD in the last 3 either f / g written here, or attach any record you have. 1.10 Dates of most recent I&R/Foundation Clinical Supervisors / Refresher or Trainers Course. f / g Please provide copies of any certificates of attendance with your application form 1.11 Date of Equality and Diversity training, to be completed no more than 3 months prior to your visit b / g () Please provide a copy of the certificate of completion with your application form Please state the number of 1.12 sessions/hours you work in the GP Practice including any tutorial sessions b (note you should available in the Practice for at 6 sessions per week) 1.13 Please indicate professional activities undertaken outside your b practice 1.14 Please enclose your supervisee GI training timetable (including time allocated to CPD sessions). NB for
Item Applicant’s Details GMC Domain 1.5 Applicant’s contact email address GI 1.6 Applicant’s mobile number (optional) GI 1.7 Date joined practice (minimum 1 year) GI 1.8 Please list your professional qualifications GI 1.9 Summary of clinical supervisor related CPD in the last 3 either written here, or attach any record you have. f / g 1.10 Dates of most recent I&R/Foundation Clinical Supervisors / Refresher or Trainers Course. Please provide copies of any certificates of attendance with your application form f / g 1.11 Date of Equality and Diversity training, to be completed no more than 3 months prior to your visit () Please provide a copy of the certificate of completion with your application form b / g 1.12 Please state the number of sessions/hours you work in the GP Practice including any tutorial sessions (note you should available in the Practice for at 6 sessions per week) b 1.13 Please indicate professional activities undertaken outside your practice b 1.14 Please enclose your supervisee training timetable (including time allocated to CPD sessions). NB for GI
Approval_Reapproval_Visit%20Report_I&R%20supervisor_2016.docx