Inspire TX|Field Supervisor Contact Log

Clinical Teacher/Intern Name: John Gorka

Field Supervisor Name: Jill Underwood
Campus: Ron Jackson State School

Total
Date Type of Contact
Time(Minutes)
1 2/7/2023 3 mins Email
2 2/13/2023 4 mins Email
3 2/17/2023 1.30 hours Face-to-face
4 3/6/2023 1.30 hours face-to-face
5 4/4/2023 2 hours Face-to-face
6 4/25/2023 2 hours Face-to-face
7 5/8/2023 2 hours Face-to-face
8 5/26/2023 2 hours Face-to-face
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
 Clinical Teacher/Intern Signature:

Field Supervisor Signature:

Reason for Contact

Introduction and attachment of forms
Setting up 1st Meeting time
1st meeting and setting up observations
1st observation and post-conference
2nd observat6ion and post -conference
3rd observation and post-conference
4th observation and post-conference
5th observation and post-conference
Date:

Date:
 Instructions for Completing Field Supervisor Contact Log
1. Enter exact number of minutes (please note you do not need to add minutes for email contact)
2. Type of contact: Phone, email, on-site, etc.
3. Reason for contact: Briefly describe reason for contact: check-in, mentor collaboration, scheduling visit, coaching, respondin
4. Signatures are required when conducting on-site visits for pre and post-conferences and observations.
tact Log
t)

uling visit, coaching, responding to questions etc.

ervations.