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Run: Clinical Intern and Student Supervision Log

Track supervision sessions, competency development, and accrued hours for therapy interns and clinical students in one signed log. Use it to document academi...

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Log Entry Details

Supervision Date (required)

Supervision Time

Session Type (required)

Supervision Mode (required)

Location or Platform

Enter the site name or virtual platform used for the session.

Supervisor Name (required)

Enter the supervising clinician's name for recordkeeping.

Supervisor Credentials

Examples: LPC, LCSW, LMFT, OT, SLP, or other applicable credential.

Student or Intern Information

Trainee Name (required)

Use the trainee's preferred professional name if that is how records are maintained.

Trainee Role (required)

Academic Program

Enter the school or training program name if needed for verification.

Training Level

Hours and Competency Review

Direct Supervision Hours (required)

Enter the number of hours spent in direct supervision for this log entry.

Indirect Supervision Hours

Enter time spent reviewing notes, recordings, or case materials outside live supervision.

Competencies Reviewed (required)

Competency Notes

Summarize strengths, coaching points, and any competency gaps identified.

Student Progress Rating

Case Focus and Follow-Up

Case or Topic Summary

Briefly describe the case discussion, training topic, or skill reviewed without including unnecessary PII.

Follow-Up Required? (required)

Follow-Up Actions

Describe any assignments, additional observation, remediation, or documentation needed before the next supervision session.

Next Review Date

Attestation and Submission

Data Use Acknowledgment (required)

This form should only collect information needed for supervision documentation and audit trail purposes.

Yes No N/A

Accuracy Attestation (required)

Yes No N/A

Supervisor Signature (required)

Trainee Signature

Use if your academic program requires trainee acknowledgment.

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Email (required)

Your name (optional)

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