Deficiency Notice/ Remediation Plan by he047H1e


									               Nursing & Allied Health Dept
        Deficiency Notice/Strategic Plan for Success


Student:                                          Faculty:
Beginning Date of Remediation:                    Ending Date of Remediation Plan:

Brief Description of the problem(s):

                Nature of the Problem                        Supportive Evidence of the Problem

 ‫ڤ‬Absenteeism                      ‫ ڤ‬Tardiness

‫ ڤ‬For Clinical Absence- Student needs to complete
      Form D-2 and give to instructor

 ‫ڤ‬Exam Failure

:lacinilC rof deraperpnU ‫ڤ‬
         eraC tneilC fo nalP yrotcafsitasnU ‫ڤ‬
         neilc hcraeser ton diD ‫ڤ‬t problems/diagnoses,
         lab values, medications, potential
         complications, etc.

:ecitcarP lacinilC efasnU ‫ڤ‬
        slliks cisab fo yretsam etartsnomed ton diD ‫ڤ‬
         VI ,segasod noitacidem etaluclac ot elbanU ‫ڤ‬
        rates, heparin drips, etc.
        ummoc ot elbanU ‫ڤ‬nicate clearly or
        comprehend the English language
        :rehtO ‫ڤ‬

edoc sserd htiw ecnailpmocnoN ‫ڤ‬

snoitadnemmocer ytlucaf no hguorht wollof ton diD ‫ڤ‬
      for remediation

:ronaemed lanoisseforp ni gnikcaL ‫ڤ‬
      tiw ylevitceffe etaler ton seoD ‫ڤ‬h faculty, staff,
               clients, and peers
      ytilaitnedifnoc tneilc detaloiV ‫ڤ‬
       yltsenoh/yllufhturt etacinummoc ton seoD ‫ڤ‬
               with faculty and staff
      :yb roivaheb elbisnopserri setartsnomeD ‫ڤ‬

       ytlucaf wollof ton seoD ‫ ڤ‬directions /
       :rehtO ‫ڤ‬

D kroW nettirW ‫ڤ‬eficit

:rehtO ‫ڤ‬

Recommendations for overcoming the problem (s):
(check all that apply)

noitaraperp lacinilc/cimedaca evorpmI ‫ڤ‬

snrecnoc cimedaca ro/dna lanosrep rof gnilesnuoc keeS ‫ڤ‬

distuo ecudeR ‫ڤ‬e work hours if possible

slliks noitacinummoc labrev evorpmI ‫ڤ‬                   slliks noitacinummoc nettirw evorpmI ‫ڤ‬
                                 slliks rotomohcysp evorpmI ‫ڤ‬

)woleb detnemucod stnemegnarra cificeps( ytlucaf htiw bal slliks gnisrun ni ecitcarp tsuM ‫ڤ‬

F etaitini ot ytlucaF ‫ڤ‬orm D-6 Skills Lab Remediation Form

Remediation Limitations/Obligation:
(check all that apply)

of etal eb ton yaM ‫ڤ‬r or absent from clinical

sisab )ycneuqerf(             a no ytlucaf htiw teem tsuM ‫ڤ‬

tnempiuqe etairporppa htiw eritta reporp ni tneserp eb tsuM ‫ڤ‬

gnitirW eht tisiv tsuM ‫ ڤ‬Center and produce a satisfactory written assignment

rehtO ‫:ڤ‬

Specific Remediation Plan Components (not addressed above):

Possible Consequences:
                                                           All Remediation Plans are in force for the
Course Withdrawal                                          entire specific nursing program.

Course Failure

After the development of the action plan or learning contract (circle one), the instructor(s) and student
will sign below:
Signed (Student)                                        Date

Signed (Faculty)                                           Date

Signed (Faculty)                                           Date

Signed (Assistant Director)                                Date

      Faculty Notes on Student’s Progress:
      When a Remediation Plan is instituted, the student and faculty will meet to evaluate progress

  Date:    Comments:                                                                   Student        Instructor
                                                                                       Initials         Initials


Date of Evaluation Conferences

lawardhtiW esruoC ‫ڤ‬
eruliaF esruoC ‫ڤ‬

 After the evaluation of the action plan or learning contract, the instructor(s) and student will sign below:
 Signed (Student)                                            Date

 Signed (Faculty)                                            Date

 Signed (Faculty)                                            Date

 Signed (Assistant Director)                                 Date

                                                                                                      Adopted 8/08
                                                                             J:wdocs/gen/forms/Remediation Plan.doc


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