Clinical Supervision Agreement Form printable pdf download

Clinical Supervision Agreement Form

Clinical supervision agreement

Clinical supervision agreement between:

Supervisor:

Supervisee:

Agreement

start date:

End date:

1. Goals of supervision

Please detail the knowledge and skills that the supervisee and supervisor would like the

supervisee to develop in supervision sessions. This will require regular review and renegotiation

as the needs and skills of the supervisee change over time.

Supervisor

goals:

Supervisee

goals:

2. Expected outcomes (specific objectives)

Supervisor

objectives:

Supervisee

objectives:

Shared

objectives:

3. Mutual obligations (responsibilities)

Obligations of

supervisor:

Obligations of

supervisee:

Management of dual roles:

Detail how dual roles (e.g. when practice supervisor is line manager) will be managed.

Example: Line manager issues will not be discussed in practice supervision sessions without mutual

consent by way of inclusion in the pre-agreed session agenda.

Clinical supervision agreement template, Queensland Centre for Mental Health Learning training resources

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Clinical Supervision Agreement Form