Trainaba - BCBA Experience Supervision Form (copyright BACB. Visit BACB.com for More Info.) Checklist

I understand these templates are provided by TrainABA to the ABA community for educational purposes as part of the supervision curriculum books at www.trainaba.com. Use of these templates does not constitute or imply proof of satisfactory supervision toward BACB credential requirements or regulations as applicable to user's country, state/province, city, funding source, work environment, or company policy. RBT and BCBA credentials are copyright of the BACB. This form was not created, distributed, or maintained by the BACB.

What kind of supervised experience did you provide?

Supervisory meeting date

Supervision meeting duration

Additional supervisory meeting date (if applicable)

Additional supervisory meeting duration (if applicable)

Supervisory meeting formats delivered in this supervisory period (check all that apply)

Individual
Group (10 or less)

Experience Hours Accumulated During This Supervisory Period (complete all four lines)

A. Number of independent experience hours accumulated (excluding time spent with supervisor - use whole number)

B. Number of individual supervision hours accumulated

C. Number of small-group supervision hours accumulated

D. Total experience hours accumulated (add lines A through C)

Of the hours listed above, state the number spent in direct implementation of behavioral programs (hint: must be 50% or less)

Characteristics of Supervision Conducted During This Supervisory Period (check all that apply)

BACB task list skills covered (list task numbers as comment on mobile)
Specific client(s) discussed
Client privacy protected
Observation of supervisee (video)
Observation of supervisee (in-person)
Supervisory discussion & feedback (in-person)
Supervisory discussion & feedback (remote)
Readings (add comment)

Evaluation of Supervisee Performance

Arrives on time for supervision

Maintains professional and courteous interactions with clients and consumers

Maintains professional and courteous interactions with other service providers

Maintains professional and courteous interactions with coworkers

Maintains appropriate attire & demeanor

Initiates professional self-improvement

Accepts supervisory feedback appropriately

Seeks supervision appropriately

Timely submission of written reports

Communicates effectively (written)

Communicates effectively (oral)

Demonstrates appropriate sensitivity to non behavioral providers

Supervisee self-detects personal limitations

Supervisee self-detects professional limitations

Acquisition of target behavior-analytic skills

Add photograph of paper supervision form of applicable

Supervisee signature: I attest the above documentation is true and correct to the best of my knowledge.

Supervisor signature: I attest the above documentation is true and correct to the best of my knowledge.

Trainaba - BCBA Experience Supervision Form (copyright BACB. Visit BACB.com for More Info.) Checklist

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