Appendices

Appendix 1 – Example Supervision Agreement

To print this document of for use in your own supervision, you can download the Appendix 1 template here

Example Supervision agreement

Name of practitioner:
Year:
Role / level of practice:
Named Practice Supervisor:
Named Management Supervisor:
Named Restorative Supervisor:
Start date of agreement:
Review date of agreement:

Location of supervision?

How will you ensure privacy and maintain confidentiality?

Frequency of supervision?

e.g. weekly / monthly / quarterly?
How long for and what time of day?
Is there protected time in both supervisor and supervisee job plan?
How will you ensure sufficient privacy and confidentiality?
Who is responsible for arranging the dates / times / location / booking of room?

What structure will your supervision take?

e.g. 1:1, peer / groups?
Face to face or remote?
Is direct or indirect supervision required?

What is the purpose of your supervision?

e.g. management / practice /restorative supervision
relating to a specific task or skill?
Is it aiming to meet specific learning or development needs, how will supervision help?

Feedback, documentation, and confidentiality

How will you evaluate and review the success and ongoing relevance of the supervision agreement?
What type of record will be kept and where?
How will you both access the record?
Who will be responsible for completing the documentation?
What are the confidentiality terms? What circumstances may require information to be shared?

Adapted from HCPC Supervision Agreement Template which can be accessed here:

https://www.hcpc-uk.org/globalassets/standards/meeting-our-standards/supervision/supervision-agreement-template-word.docx

Supervision agreement

Name of practitioner:
Year:
Role / level of practice:
Named Practice Supervisor:
Named Management Supervisor:
Named Restorative Supervisor:
Start date of agreement:
Review date of agreement:

What is the purpose of your supervision?

Frequency of supervision?

Location of supervision?

What structure will your supervision take?

Feedback, documentation, and confidentiality

Other comments

Adapted from HCPC Supervision Agreement Template which can be accessed here:

https://www.hcpc-uk.org/globalassets/standards/meeting-our-standards/supervision/supervision-agreement-template-word.docx

Appendix 2 – Example Supervision log

To print this document of for use in your own supervision, you can download the Appendix 2 template here

Name of practitioner:	My name
Year:	2024
Role / level of practice:	Rotational NQP (band 5)
Named Practice Supervisor:	name
Named Management Supervisor:	name
Named Restorative Supervisor:	name

Week beginning	Informal	Practice supervision (formal)	Restorative supervision (formal)	Management supervision (formal)
1/1/24	3/1/24 – 10 min 5/1/24 – 5 min
8/1/24	8/1/24 – 20 min 10/1/24 -5 min	11/1/24 – 40 mins
15/1/24	15/1/24 – 5 min 16/1/24 – 5 min 17/1/24 – 5 min 18/1/24 – 5 min		17/1/24 – 60 mins
22/1/24	23/1/24 – 10 min 25/1/24 – 5 min	24/1/24 – 35 min
29/1/24	29/1/24 – 10 min 30/1/24 – 10 min			2/2/24 – 60 min

Name of practitioner:
Year:
Role / level of practice:
Named Practice Supervisor:
Named Management Supervisor:
Named Restorative Supervisor:

Week beginning	Informal	Practice supervision (formal)	Restorative supervision (formal)	Management supervision (formal)

Appendix 3 – Example Supervision Template

This example supervision template is available on the HCPC website here: Supervision templates | (hcpc-uk.org)

Or to print this document of for use in your own supervision, you can download the Appendix 3 template here

Name of supervisee:
Name of supervisor:
Date of meeting:

What’s the aim or purpose of your supervision session?

Supervision can have multiple objectives, such as discussions of your caseload,

assistance with particular tasks or challenges; wellbeing checks; workload

planning; or debriefing discussions.

It’s important that your supervision has a clear focus. You should try to keep the

purpose of your supervision as targeted as possible by identifying clear actions

and objectives at the beginning of each session.

If this is a follow up session, it could be helpful to review notes of your last meeting

to discuss previous actions identified and any progress made against these.

What goals have you achieved since your last supervision?

When discussing your achievements, you may also consider how you have put

this learning into practice and how this has contributed towards your professional

development.

What challenges have you faced since your last supervision?

You may want to outline any challenges that you have faced since your last

supervision, and what you have done to overcome these.

If any challenges remain, you could outline what’s needed to help you overcome

these going forward.

What future learning objectives have you identified and what do you hope to achieve before your next supervision?

How will you achieve these objectives, and by when?

How will these contribute towards your professional development?

Will you need any additional support?

Feedback from supervisor

Feedback should be clear and focused. It should also be evidence based, which

means clearly outlining the reasons for any comments provided.

Identifying clear actions and objectives will help ensure feedback is constructive,

but you should also use this section to reiterate/highlight any achievements and

progress made.

What actions have been agreed?

Think about what you have learnt from this supervision session, and what will you

do differently.

When will your next supervision session be?

Agree a date, time and venue for your next session.

Signed: (Supervisee)
Date:

Signed: (Supervisor)
Date: