BSC in Operating Department Practice
Clinical Attendance Record - 4 Week Placement
Students Name
Matriculation Number
Hospital/Specialty
Anaesthetics / Surgery / Anaesthetics & Surgery / Immediate postoperative care
(please circle one only)
Please read the following instructions before completing this form.
1.
In the Hospital/specialty section, print the name of the hospital and the specialty, e.g. Stobhill, general
surgery.
2. Complete one table for each week of your placement.
3. Complete every day of the table, even if you are not on duty.
4. The shift start time should be completed in the “from” column and the finish time should be entered in
the “to” column. The number of hours actually worked should exclude time taken for meal breaks.
Hours should be calculated to the nearest 0.25 of an hour.
5. If you attend an authorised study day, insert the word Study Day in the “from-to” column and enter 7.5
in the daily total.
6. If you are sick, write Sick in the “from-to” column and a “0” in the daily column.
7. If you are on a day off, write Day Off in the “from-to column” and “0” in the daily column.
8. Add up the daily totals and enter this in the total hours worked column.
9. Enter the sum of the weekly hours in the “total placement hours worked” box at the end of the form.
10. Both you and your mentor should sign the final section of the form.
11. Completed forms should be handed to the Programme Administrator.
12. Incomplete or incorrectly completed forms will be returned to the student for amendment.
An example of a completed week can be seen below:
Week Commencing
3/5/06
From
To
Daily Total
Monday
8.30
17.15
8.25
Tuesday
8.30
17.15
8.25
STUDY DAY
Wednesday
7.5
Thursday
8.30
17.15
8.25
Friday
8.30
13.45
5.25
Saturday
DAY OFF
0
Sunday
DAY OFF
0
Total hours worked
37.5
Reporting of Sickness/Absence:Contact Clinical Placement and Contact Module Leader
on 0141 331 3498
Week Commencing
From
To
Daily Total
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total hours worked
Week Commencing
From
To
Daily Total
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total hours worked
Reporting of Sickness/Absence:Contact Clinical Placement and Contact Module Leader
on 0141 331 3498
Week Commencing
From
To
Daily Total
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total hours worked
Week Commencing
From
To
Daily Total
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total hours worked
Total placement hours required
150
Total placement hours worked
Student’s signature of confirmation
Mentor’s signature of confirmation
Reporting of Sickness/Absence:Contact Clinical Placement and Contact Module Leader
on 0141 331 3498