CHIR20002 CP1: CLINICAL ATTENDANCE FORM

Student Name: Student Signature:

Thomas Hemmings
Student Number: Type text here
12051778
Clinical Supervisor Name: Clinical Supervisor Signature:
Ben Fillipi
Clinical Site Name:
B Chiropractic Date: 01 / 10 / 21

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

Week 1

Date Weekly
13/09/21 15/9 16/9 17/9 18/9 Totals:
Hours
Worked 11.5 11.5 2.5 9.5 4 39
Week 2

Date Weekly
20/9 22/9 24/9 Totals:
Hours
Worked 8.5 8 4.5 21
Week 3

Date Weekly
27/9 29/9 30/9 01/10 Totals:
Hours
Worked 11.5 11.5 2.5 5 30.5
Week 4
5th year placement and Mooloolaba outreach
Date Daniel Harris-Wolf Weekly
26/7/21 04/09 Total:
Hours
Worked 3.5 6.5 10

TOTAL HOURS WORKED OVER 4 WEEK PLACEMENT: