MSW STUDENT SUPERVISION RECORD
Agenda & Record of Discussion
Submit with Mid-Placement and Final Evaluation
Instructions – The primary areas of foci in social work supervision are to: 1) provide a consistent opportunity for the supervisee to reflect on the content and process of their work; 2) develop understanding and skills within the work; 3) receive information and another perspective concerning one’s work; 4) receive both content and process feedback; 5) be validated and supported in their professional development; 6) provide support around difficulties, including issues of transference and countertransference; 7) plan and utilize personal and professional resources better; 8) be proactive rather than reactive; and, 9) ensure quality of work. Learning Contract activities/ UB SSW Competencies and Practice Behaviors should be addressed in supervision.
Supervisee: Click here to enter text. Field Educator: Click here to enter text. Task Supervisor (If Applicable): Click here to enter text.
Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
Click here to enter text.
Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
Click here to enter text.
Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
Click here to enter text.
Supervisee Questions
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Actions; Recommendations; By Whom; When
Click here to enter text.
Next Meeting:
Click here to enter text.
Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
Click here to enter text.
Next Meeting:
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Date of Supervision: Click here to enter text. Session Length: Click here to enter text.
Attendees:
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Key Discussion Points; Client Issues
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What Went Well in Practice; Areas for Improvement
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Supervisee Questions
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Actions; Recommendations; By Whom; When
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Next Meeting:
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Supervisor Signature: Supervisee Signature:
This is an agreed upon record of the supervision session. Students are responsible for reviewing these forms with their liaison. (Continue on to next page if needed.)
The goal of supervision is good social work practice.
(University at Buffalo, School of Social Work 2013)
Q:\Taskstream\Student Supervision Record - Generic.docx