Supervision Form

Supervising staff to ensure that they read and understand the PP08 Supervision Policy and Procedure before carrying out employee supervisions and that employee has read and understood the supervision agreement.
Carer Name *
Date *

Day Month Year
Date

Please score your own capability or knowledge in the following areas in terms of your current role requirements. (1 =very poor, 3= average, 5=very good) *

	1	2	3	4	5
Care Equipment Knowledge
Time Management
Reporting / Document Completion
Communication Skills
Delegation Skills
Client Relations
Problem Solving
Team Working Skills
Working Under Pressure
Adaptability
Personal Appearance/Image
Attendance at Work

Any other comments about your development or things you would like to discuss?

Rota *
Check with the employee that they are happy with their current rota or have any issues. Objective: Ensure needs of employee and HG care are met as fully as possible.
Actions Required?
Health and Safety *
Discuss with the employee their understanding of a safe workplace environment. Highlight any significant risks that they may not have identified
Actions Required?
Safeguarding *
Discuss with employee any concerns they have over the wellbeing of service users.
Actions Required?
Whistleblowing *
Discuss with the employee their understanding of the Whistleblowing policy. Explain any aspects of the procedure that they may not be sure of.
Actions Required?
Concerns or Worries *
Check with the employee if they have any grievances, either with HG Care or an individual member of staff. Objective: Ensure employees wellbeing to prevent problems being left unresolved.
Actions Required?
Personal Development *
Check how training is benefitting employee,
Actions Required?
Timekeeping and Attendance *
Check with the employee if they have any grievances, either with HG Care or an individual member of staff. If issues have been raised, try to establish the cause of these e.g. personal, transport issues, rota etc. so these can be resolved.
Actions Required?
Standard of Working *
Review the employees work performance against HG Care and CQC standards.
Actions Required?
Working with colleagues *
Check with the employee if they have any concerns about other employees (whether this is work performance related or personal reasons)
Actions Required?
Feedback from other employees and service users *
Inform employee of any feedback (positive and negative) and record below.
Actions Required?

Since your last supervision, have you had any criminal convictions? *

Yes No
Have you got any upcoming holidays, hospital appointments etc.? *

Yes No
If yes on holidays, please provide details

	1	2	3	4	5
Your Rota (amount of work)
Support from office
Training Provided
Development (training/courses
New Opportunities (jobs)
HG Care Overall