Professional Placement planning report template
This form should be completed during the initial professional placement-planning meeting.
It is finalised when the student, placement co-ordinator and supervisor have agreed to the
reasonable accommodations specified below.
Name:
Student No:
Course:
Disability:
Disability Officer:
Date of meeting:
In attendance:
Placement Information
Placement details
(Provide details of placement location, durations, times, dates, schedule etc)
Placement supervisor
(Name and contact details of placement supervisor, manager or preceptor)
Possible disclosure in the future if required
Specify
Disability Supports
(Name and contact details)
Core competencies
(List or provide link to core competencies :)
Disclosure of disability and information
With consent from STUDENT NAME, HE/SHE has agreed to disclose HIS/HER/ DISABILITY
as stated above.
Disability information relevant to disclosure
Provide details of the level of disclosure required for placements
What will be disclosed, to whom and when?
Impact of disability on placement (delete and amend as required)
Physical access or mobility
Attendance and time keeping
Fatigue and Stamina
Manual and/or patient handling
Co-ordination difficulties with: learning
new tasks/ operating equipment/ patient
handling
Organisational difficulties
Communication: verbal, written, nonverbal
Concentration
Motivation
Memory difficulties with: long or
Stress & anxiety related to: attendance/
complex information or
self-confidence/ groups/ formal
instructions/names and client details/
meetings/ speaking in public/
presentations/ carrying out specific
tasks/ interacting with public
Report writing
Memory
Reasonable Accommodation while on placement (Delete and amend as appropriate)
Maintain confidentiality/do not disclose to Allow or provide time and space for the
other students, staff or clients of the
student to take rest breaks, self-administer
service
medication or monitor blood sugar levels as
required
As soon as possible provide or allow time
Provide daily/regular feedback on progress
for an orientation of the placement venue,
meeting key staff and clarifying placement
requirements
Provide flexibility on attendance and
Allow additional time to: develop practical
deadlines as appropriate
skills/ write or produce reports/complete
physical tasks/communicate/travel to other
locations
Avoid or minimise tasks that are not
Provide accessible locations and avoid or
essential to core competencies but which
minimise prolonged sitting, standing or
may present the student with an additional
walking
burden
Reduce daily hours
Reduce days per week
e.g. 3 days x 12hrs to 4 days x 9hrs
e.g. 8 weeks x 5 days to 10 weeks x 4 days
Allow student to use assistive technology
Avoid or reduce manual/patient handling
such as a digital recorder, laptop etc
tasks
As required, modify or provide alternative
Provide relevant placement procedures and
methods for meeting core competencies
information in alternative formats or as
that do not compromise professional or
enlarged copies if required.
health and safety standards
Written by XXXXXX of the Trinity College Disability Service
Further details on supporting students with disabilities on placement, please review information and
download booklet at: http://www.tcd.ie/disability/services/placement-planning.php