CLINICAL PLACEMENT ATTENDANCE FORM

Student Name: Matthew Bowe Student Signature:

Student Number: s0281534

Clinical Supervisor Name: Dr Andrew Clinical Supervisor Signature:

Timbs & Dr Carrie McDowall
Clinical Site Name: Purity Chiropractic
Date: 02/06/2021

80 hours of observation over 4 weeks is required to pass the clinical placement component of CP1.
Week 1

Date 10/05/2 12/05/2 13/05/2 14/05/2 15/05/2 Weekly

1 1 1 1 1 Totals:
Hours 9am – 9am – 9am – 9am – 8:30am 35hrs
Worked 5pm 5pm 7pm 2pm -
(8hrs) (8hrs) (10hrs) (5hrs) 12:30p
m
(4hrs)
Week 2

Date 17/05/2 19/05/2 20/05/2 21/05/2 22/02/2 Weekly

1 1 1 1 1 Totals:
Hours Closed 9am – 9am – 9am – 8:30am 26hrs
Worked 5pm 7pm 1:30pm -12:30
(8hrs) (10hrs) (4hrs) (4hrs)
Week 3

Date 24/05/2 26/05/2 27/05/2 28/05/2 29/05/2 Weekly

1 1 1 1 1 Totals:
Hours 9am – 9am – 9am – 9am – 8:30am 31hrs
Worked 3pm 3pm 7pm 2pm -
(6hrs) (6hrs) (10hrs) (5hrs) 12:30p
m
(4hrs)
Week 4

Date 31/05/2 02/05/2 03/05/2 04/05/2 Weekly

1 1 1 1 Total:
Hours _____ 9am – 9am – 8hrs
Worked 1pm 1pm ______
(4hrs) (4hrs)

TOTAL HOURS WORKED O VER 4 WEEK PLACEMENT: 100hrs

Weekly CQUniversity Observations Log sheet

Use this this table to record your weekly observations with a 5 th yr Senior Intern at
the CQUniversity Health Clinics.

Date Shift Start Senior Intern Supervisor Hours /

Time Signature Signature (Total)
17/04/2021 7:30am – Dan 8hrs
(Warwick 3:30pm
outreach)
Page 2 of 2