Issued by Chief Executive

Issue Date: February 2013

Page 1 of 6

SUPERVISION FORM (for non social care staff)

Staff Payroll No / Date
Staff Member
Line Manager
Location
Topics to be discussed (agree at beginning of supervision session)
1. / Actions and minutes of previous supervision:
Update and progress on agreed action
2. / Aims and Objectives of service, department , organisation’s mission statement:
Role & responsibilities: How has the individual performed against defined roles and responsibilities as detailed in JD and any applicable individual/departmental objectives/action plans? How has the individual contributed to the aims and objectives of the department/organisation? It might be useful to identify an area of strong/good practice as well as an area that requires development and support
3. / Communication/Team work:
Individual communication, effective team work:How has the individual demonstrated effective communication skill in the execution of his/her duties? How has the individual contributed to the overall performance of the team?
4. / Policy & Procedure updates: Have there been any organisational or service policy updates since previous supervision? Do any areas of individual or team performance highlight a need for policy review, discussion or training?
5. / Health & Safety & Incident follow ups: Have there been any incidents or H&S policy updates since previous supervision? Do any areas of individual or team performance highlight a need for policy review, discussion or training?
6. / Service/ Service User / Customer issues: Have there been any issues relating to services, service users, staff or customers that require exploring or addressing?
7 / Compliance / Standards:are any external or internal inspection or improvement plans currently being implemented that apply to the department or work of the individual supervisee? How does the supervisee contribute to the progress of these?
Is the supervisee conversant with policy and legislation that relate to his/her duties?
8 / Personal Development/Support and Wellbeing: What training or learning needs are currently being supported? Does the supervisee feel that his/her needs are known and met? Has the supervisee attended training since the previous supervision- if yes, has the training had a direct impact on the supervisee’s performance?
What if any additional support needs does the supervisee have. Are there any issues with workloads/distribution of work, attendance, health and wellbeing, general performance etc. and what can be put in place to support the supervisee?
9 / Finance/contracts/budgetary performance (For Managers undergoing supervision)
How is the department performing financially?
Is the department/section working within budget?
Have actions been agreed to manage/improve financial performance?
10 / Team and staff development (For Managers undergoing supervision)
What HR / staff matters are currently being managed by the supervisee? What KPIs relate to the management of staff that the supervise is responsible for?
Have actions been agreed to support team members managed bythe supervisee? Have sickness and absence, training, performance and qualification targets met? Are staff managed by the supervisee receiving supervision and support?
11 / General discussion/concerns & queries/ AOB

Agreed Actions

Actions / Responsible Person / Date Required / Date Completed
Line Manager Signature. / Date
Staff Member Signature / Date
Date of Next Supervision

A COPY of this document is kept in a confidential file by the Line

Manager.

The ORIGINAL document is retained by the Employee. Please note that

confidentiality in relation to service user or other employee matters must be

maintained.

Comments/further actions required:
Line Manager’s Signature / Date