Enrolment Form
Section 1 – the Applicant and the Supervised Practice Provider[1]
1.1 Candidate Information
Name:Membership Number:
E-mail address:
Telephone numbers: / Work:
Mobile:
Job role of candidate, with key responsibilities
Highlight here the key aspects of the role that will help the candidate meet the requirements of the Qualification
1.2 Supervised Practice Host information[2]
Organisation:Address:
Main business of Organisation:
Line manager:
E-mail address:
Telephone numbers: / Work:
Mobile:
Candidate’s primary contact person at the workplace (if different). Please give brief information about qualifications and professional registrations relevant to the requirements of the Qualification
If the primary contact person at the supervised practice host is the Co-ordinating Supervisor or a Designated Supervisor then please just say “Co-ordinating Supervisor” or “Designated Supervisor” and complete the following sections.
Is the primary contact person the Candidate’s line manager?
E-mail address:
Telephone numbers: / Work:
Mobile:
1.3 Co-ordinating Supervisor Approval information
Name:Address:
BPS membership Number: / HPC Registration Number:
Full member of the Division of Occupational Psychology? / Yes q
No q / On the Register of Applied Psychology Practice Supervisors (RAPPS)? / Yes q
No q
E-mail address: / Telephone numbers: / Work:
Mobile:
Current work/post:
Is the Co-ordinating supervisor external to the employer?
Experience in training or mentoring (Number of Years):
1.4 Designated Supervisor Approval information (to be completed only if a Designated Supervisor is to be appointed)
Name:Address:
Registration/Accreditation status (organisation and number)
Please give brief information about the suitability of the Designated Supervisor in relation to the requirements of the Qualification.
E-mail address: / Telephone numbers: / Work:
Mobile:
Is the Designated Supervisor external to the supervised practice host?
Relevant Qualifications:
Experience in training or mentoring (number of years):
1.5 Welfare and wellbeing while on placement
Please provide details of a named person at your organisation/company who can approach to discuss any issues relating to our welfare and wellbeing while on placement. Ideally this will be a counselling/support service or an occupational health team to which you have access.
Name of welfare and wellbeing contact:Contact details:
Role within supervised practice host setting:
If you are unable to provide details of a suitable welfare and wellbeing contact, please refer to the guidelines for completing the enrolment form for details of how to proceed.
1.6 Health and Safety Contact
Please provide details of a named person at your organisation/company who can approach to discuss any health and safety issues whilst undertaking supervised practice experience. Ideally this will be the employer’s health and safety officer.
Name of health and safety contact:Contact details:
Role within supervised practice host setting:
1.7 Qualifications required to enrol on the Qualification in Occupational (Stage 2)
1.7.1 Graduate Membership of the Society with the Graduate Basis for Chartered Membership (previously Graduate Basis for Registration)
q I have the Graduate Basis for Chartered Membership and I am a Graduate Member of the Society
1.7.2.1 Stage 1 Qualification in Occupational Psychology (please tick as appropriate) – See Guidance Notes for the type of evidence required
q I have undertaken a Society accredited MSc in Occupational Psychology
University:Date commenced: / Date completed:
1.7.2.2 Stage 1 Qualification in Occupational Psychology – Undertaken outside the UK - See Guidance Notes for the type of evidence required
q I have undertaken an MSc in Occupational Psychology in a country outside of the UK and the Occupational Psychology Qualifications Board has reviewed the details of my qualification and agreed that I am eligible to enrol.
Date of letter from the Occupational Psychology Qualifications Board:1.8 Supervised Practice Agreement - Responsibilities of Each Party
The Co-ordinating Supervisor (CoS) will: / Details or initial to confirm- Ensure they are eligible for and have applied to be included on the Society’s Register of Applied Psychologist Practice Supervisors (RAPPS)
- Agree a supervision contract with the candidate and abide by its terms
- Abide by the role description for the Co-ordinating Supervisor provided in the Supervisor Handbook
- Undertake the required introductory and refresher training specified in the Supervisor’s Handbook
- Review the Supervised Practice risk assessment and discuss any issues arising with the supervised practice host
- Conduct the workplace audit which forms part of this enrolment form
- Provide regular supervision to the candidate and document as required by the Qualification Handbook, including quarterly reviews
- Sign the candidate’s Annual Progress report and Annual Submission documentation and any other documentation as appropriate
The Supervised Practice Host will: / Details checked/ agreed by CoS
- Conduct a risk assessment to assure a safe workplace setting with the candidate. Any issues which need to be addressed should be noted, with an explanation of the resolution, and included in the risk assessment submitted to us
- Provide an induction, including Health and Safety policies and regulations relevant to the workplace
- Provide an honorary contract (if the trainee is not an employee), or a contract of engagement for a particular project (where appropriate)
- Provide an appropriate work setting including appropriate facilities to conduct client work
- Abide by the Disability Discrimination Act with regard to any reasonable adjustments which may be required work
- Provide the candidate with Professional Indemnity Insurance as appropriate
- Keep in mind the supervised practice requirements of the candidate when assigning work wherever possible
The Designated Supervisor will: / Details checked/ agreed by CoS
- Maintain communication with the Co-ordinating Supervisor as appropriate
- Agree the arrangements for supervision with the candidate and ensure these are reflected in the contract (if one is used)
- Provide the Co-ordinating Supervisor with feedback regarding the trainee’s progress, for inclusion in the Quarterly Supervision Meetings
The candidate will: / Details checked/ agreed by CoS
- Provide the supervised practice host with a Candidate Handbook and other relevant documentation
- Agree beginning and ending dates for the placement
- If an external supervisor is to be used provide the employer with the Supervisor’s name, registration status and contact details
- Abide by the Health and Safety Regulations of the employer and organisational policies and with the British Psychological Society’s Code of Ethics and Conduct and Membership Conduct Rules and the HPC’s Standards of conduct, performance and ethics and HPC’s Guidance on conduct and ethics for students
- Attend Supervision meetings agreed with the Co-ordinating Supervisor and/ or the Designated Supervisor and prepare for these appropriately
1.9 Supervised Practice Objectives
Please tick the competences it is intended to address in this postGeneric Skills
· Questionnaire or Survey Design / · Presentation Skills
· Interviewing / · Statistical Skills or Qualitative Analyses
· Report Writing / · Evaluation Techniques
Knowledge Areas (five out of the eight)
· Human Machine Interaction / · Counselling and Personal Development
· Training / · Employee Relations and Motivation
· Personnel Selection and Assessment / · Design of Environments and Work: Health and Safety
· Performance Appraisal and Career Development / · Organisational Development and Change
Fields of Practice (indicate at least one of four)
· Work and the Work Environment / · The Organisation
· The Individual / · Training
Key Role Competences
Key Role 1: Develop, implement and maintain personal and professional standards and ethical practice
Key Role 2: Apply psychological and related methods, concepts, models, theories and knowledge derived from reproducible findings
Key Role 3: Research and develop new and existing psychological methods, concepts, models, theories and instruments in occupational psychology
Key Role 4: Communicate psychological knowledge, principles, methods, needs and policy requirements
1.10 References
The Occupational Psychology Qualifications Board requires you to obtain two references in relation to your training and practice in occupational psychology. One reference must relate to your academic studies and the other reference must relate to your practice. At least one name must be a Chartered Member of the Society and appear on the psychology section of the Health Professions Council’s Register. In both cases original signatures must be provided. You are not permitted to name your Co-ordinating Supervisor as a referee. You are also not permitted to use fellow Trainee Occupational Psychologist as referees.
You will need to download and submit the document called “Reference Request Form” along with the rest of your application form.
Section 2 – the Supervised Practice (Work Place) Audit [3]
2.1 Supervised Practice Host Approval
/ Score (0-5) /Date
2.1.1 / Will this supervised practice contribute to the Candidate’s overall supervised experience by providing experience which meets the Candidate’s needs in terms of the competences?
2.1.2 / Has a risk assessment been undertaken (See Section 3)?
2.1.3 / Does the supervised practice provider have induction materials and an induction process?
2.1.4 / Do the induction materials and induction include:
· Health and safety policies
· Practical information about the site (fire escapes, toilets, lunch facilities etc)
· Grievance and disciplinary policies
· Workplace policies
2.1.5 / Does the employer have an Equality and Diversity policy and monitor its implementation?
2.2 Supervised Practice Host Assessment
/ Score (0-5) /2.2.1 / Objectives will be set and assessed as part of the Quarterly Meeting. Has an assessment strategy been agreed with the Candidate?
2.2.2 / Has the assessment strategy been discussed with the supervised practice provider?
2.2.3 / Will the supervised practice provider be able to contribute to the assessment?
2.2.4 / Has the assessment strategy been written down in a document available to the candidate, Designated supervisor, supervised practice provider and Co-ordinating Supervisor?
2.3 Supervised Practice support
/ Score (0-5) /2.3.1 / If a Designated Supervisor is to be used are they appropriately qualified and experienced?
2.3.1a / Are regular supervision sessions agreed in advance?
2.3.1b / Is the Candidate able to contact the Designated Supervisor between supervision sessions?
2.3.2 / Is the Candidate able to contact the Co-ordinating Supervisor?
2.3.3 / Is the Designated Supervisor able to contact the Coordinating Supervisor?
2.3.4 / If the Co-ordinating Supervisor is off site, is there a named person on site who the Candidate can approach for support (please provide details on the enrolment form)?
2.3.5 / Does the supervised practice provider employ other appropriately qualified staff who can provide day to day support?
2.3.6 / Will the Candidate be working in a multi-disciplinary team?
2.3.7 / Is the line manager aware of the Candidate’s status as a Trainee Occupational Psychologist?
2.3.8 / Have arrangements for study time and supervision time been agreed with the line manager?
2.3.9 / Has the line manager agreed to the Candidate discussing confidential aspects of the work with the Co-ordinating Supervisor within supervision sessions?
2.3.10 / If the Co-ordinating Supervisor is external will they be able to visit the site during the placement?
2.3.11 / Have the Co-ordinating Supervisor and Designated supervisor (if one is to be used) agreed a process to monitor and record progress on placement?
Action plan
Audit question scoring 2 or less / How can the score be improved? / Who will need to help with this and what resources will be needed? / Date at which action reviewed / Date at which CoS confirms action completed /
Section 3 – the Risk Assessment - to be completed for the whole of the Supervised Practice[4]
TO BE COMPLETED FOR EACH SUPERVISED PRACTICE HOST
Name of Supervised Practice Provider (Employer):Address:
Health & safety contact :
Telephone:
Email:
Yes/No / Any action required?
Who by and when?
Has the candidate been provided with a copy of the following policies:
· Written Health and Safety policy
· Health and safety training for employees
· Process for reporting health and safety concerns
· Violence and Aggression policy
· Lone working policy
· Procedure to be followed in the event of serious and imminent danger
Are there any other risks specific to your organisation?
Has the supervised practice provider carried out a risk assessment of their work practices to identify possible risks to their employees and others within their organisation?
Are risk assessments kept under regular review?
Are the results of risk assessment implemented?
Work factors
Yes/ No
(If yes specify) / Risk assessment: High/ Medium / Low[5] / Is there a policy, practice or procedure to control or minimise risk?
(attach policy where appropriate)
Are there any work hazards which have the potential to cause serious injury, ill health or fatalities?
Will the candidate be working with known high risk groups (for example, violent offenders) or dangerous equipment?
Will the candidate be working alone?
Travel and transportation factors
Yes/ No / Risk assessment: High/ Medium/Low[6] / Is there a policy, practice or procedure to control or minimise risk?
(attach policy where appropriate)
Is there any travel associated with the role? (for example, driving between sites)
If the candidate is using a company/ pool car is appropriate insurance in place?
If the candidate is required to use their own car do they have appropriate insurance in place?
Location and/ or regional factors
Yes/ No
(If yes specify) / Risk assessment: High/ Medium/ Low / Is there a policy, practice or procedure to control or minimise risk?
(attach policy where appropriate)
Are there any risks associated with the location of the workplace? (Examples might include a high crime area; leaving the organisation late at night?)
Are there any communication difficulties which might affect the operation of other policies (for example, lack of mobile phone coverage might make it difficult for a candidate to phone for help from a remote area).
General/ environmental health factors
Yes/ No
(If yes specify) / Risk assessment: High/ Medium/ Low / Is there a policy, practice or procedure to control or minimise risk?
(attach policy where appropriate)
Are there any particular health precautions required to work on the site/ in the area?
Has the Candidate been given information and training about these precautions?
Will you check precautions have been taken before allowing the supervised practice to commence?
Individual candidate factors
Yes/ No
(If yes specify) / Risk assessment: High/ Medium/ Low / Are you able to make appropriate adjustments to control or minimise the risk?
Does the Candidate have personal factors (for example health, disability, linguistic or cultural) which may increase the risk of illness or accident during work related activity?
Does the Candidate have the relevant knowledge, understanding and skills for the type of work to be undertaken?
Insurance Factors
Yes/No / Any action required?
Who by and when?
Does the employer or Candidate hold the following insurance cover and will the candidate be covered by these policies:
· Public Liability Insurance
· Employers Liability Insurance
· Professional Indemnity Insurance
CANDIDATE’S DECLARATION: