Deficiency Notice/ Remediation Plan by he047H1e

VIEWS: 65 PAGES: 4

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

Date:

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



                                                         1
: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 /
               instructions
       :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




                                                      2
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
Signatures:

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


                                                       3
  Date:    Comments:                                                                   Student        Instructor
                                                                                       Initials         Initials




Outcomes:

Date of Evaluation Conferences




lawardhtiW esruoC ‫ڤ‬
eruliaF esruoC ‫ڤ‬
 Signatures:

 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




                                                         4

								
To top