SUPERVISION | Our Mindful Youth | Victoria's Creative Therapists

Professional Supervision Record
Occupational Therapy

Please complete and send the Professional Supervision Record to your supervisor via email within 48 hours of the supervision session. Your supervisor will review, sign and return to you via email

Supervisee Details

First name

Last name

Date of Birth

Mobile number

Email address

Professional Supervision details

Supervisor name

Date of supervision session

Duration of sesson

Session number

Session location

Reflective Discussion

Management

(What has worked well in service provision; any issues related to safety or quality of practice; managing professional
and organisational expectations; impact of new policies or procedures)

Support

(Current stressors or issues related to staff wellbeing; the demands of the practice environment; interactions with
services users; directing to appropriate help)

Development

(Progression and awareness of personal and professional skill development; feedback from training; professional
development needs and opportunities)

Mediation

(Access to organisation systems or resources; liaising with external organisations)

Additional matters discussed

Write 'NA' if no addition matters were discussed

Agreed Actions

Supervisee Actions

Supervisor Actions

Session Evaluation

What insights did you uncover during the session? What will these insights mean for your clinical practice and for the people you serve?

Signature

Supervisee Signature

Supervisor Review and Signature

Additional comments

Supervisor Signature

Date