Supervisor' comments

Good attendance


Well presented

Shows interest

Works well as part of a team

Able to follow instructions

Works well under own intiative

Interacts well with clients/children

Completes tasks required

Applies Care Value Base

Respectful at all times

Able to deal with problems

Asks for help and advice

Accepts constructive criticism

Listens to others

Supervisor' comments

Supervisor's signature

Student Experience

Health and Safety Checklist completed

Attendance record up to date

Number of Witness Statements completed.
Number of Ten Key Themes completed

Comments from Student

Comments from Work Placement Coordinator


Areas for development


Action Plan

Personal Development

College Paperwork


Work Placement Coordinator
Date of observation
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.