CLINICAL PLACEMENT ATTENDANCE FORM

Student Name: Brooke Phillips Student Signature:

Bphitbips
Student Number: 12080174

Clinical Supervisor Name: Rhys Dale Clinical Supervisor Signature: Jffy

Clinical Site Name: Cleveland chiropractic
Date: 2
/ 10
/ 21

100 hours of observation over 4 weeks is required to pass the clinical placement component of CP1.
/

Week 1 Mentor Meeting

attended
Date Weekly
13/09 1419 15/9 16/9 Totals: Wednesday
Hours 30
II. 25 7.75 5.5 5.5
Worked
Week 2

Date Weekly
20/921/9 22/9 2319 24/9 25/9
Totals: Wednesday
Hours
Worked 7 8 5.5 5.5 4-5 5 35.5

Week 3

Date Weekly
27/9 28/929/9 30/9 1/10 2110 Totals: Wednesday
Hours
7 8 5.5 55 4.5 4.5
35
Worked
Week 4

Date Weekly
Total:
Hours
Worked
TOTAL HOURS WORKED OVER 4 WEEK PLACEMENT: 100.5