Placement Calendar
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Insert the dates the weeks commence for the length of the placement (eg Monday 24/06/2012)
Indicate each day you have attended on placement by putting a tick in the appropriate box.
Indicate any days you would normally have been expected to attend placement, but did not
actually attend (whatever the reason) but putting an O in the box.
Give the total number of days attended in the space indicated, plus start and end dates. The
completed form must be signed off by your Practice Educator (and Practice Supervisor, if
appropriate) and returned with your final placement report.
Please ensure that the Practice Educator or Supervisor has a copy which is passed to the Finance
Department of the placement agency.
Student Name:
Placement Start Date:
Placement End Date:
Agency Name:
Week beginning:
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
M
T W
T
F
S
S Week beginning:
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Monday
Total number of days attended
Practice Educator name:
Practice Supervisor name (if appropriate):
I confirm that the above is true and accurate record of attendance
Student signature:
Practice Educator signature:
Practice Supervisor signature (if appropriate):
M T
W T
F
S
S
Notes: