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Corrective-Action-Plan - Corrective Action Plan

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1
Adapted from UCLA School of Social Work Corrective Action Plan courtesy of Joseph Nunn, Ph. D
CALIFORNIA STATE UNIVERSITY, FRESNO
DEPARTMENT OF SOCIAL WORK EDUCATION
UUCorrective Action Plan
For
Unsatisfactory Student Performance in Field Placement
(Refer to the Field Manual for course requirements and grade procedures).
Note: To be completed by the faculty liaison in consultation with the student, field instructor, and field
coordinator.
DATE:
STUDENT NAME:
First Name MI Last Name
STATUS: BA (1P
st
P
semester) BA (2P
nd
P
semester) MSW1 MSW2
PLACEMENT AGENCY
FIELD INSTRUCTOR
FACULTY LIAISON
ACADEMIC ADVISOR
UUIdentified Performance IssuesUU : (please attach additional supporting documentation if necessary)
1.
2.
3.
4.
Date Rcvd: __________ Initial_____
2
Adapted from UCLA School of Social Work Corrective Action Plan courtesy of Joseph Nunn, Ph. D
UUPerformance Area UUCurrent Level of Performance
0B0B Satisfactory Marginal Unsatisfactory
1. Professional Development
a. Attendance and
Time Management:
b. Use of Supervision:
c. Completion of Assignments
UU Current Level of Performance
1B1B Satisfactory Marginal Unsatisfactory
2. Multi Systems Social Work Practice:
a. Practice with Clients
b. Practice with Staff
d. c. Practice with Administration
UU
Performance Area UU UUCurrent Level of Performance
Satisfactory Marginal Unsatisfactory
3. Assumption of Professional
Responsibility for:
a. Skill Development
b. Assignments
c. Professional Demeanor
2B2B
4. Other (Please Specify below)
3
Adapted from UCLA School of Social Work Corrective Action Plan courtesy of Joseph Nunn, Ph. D
Corrective Plan
Instructions: The corrective action plan is to be completed by the Faculty Liaison in consultation with the
student, the field instructor and the Field Coordinator. Address all performance issues noted above and provide
clear objectives for satisfactory performance that include a specific, short term time frame.
Performance Objectives: Time Frame:
1.
2.
3.
4.
5.
Field Instructor Will: Time Frame:
1.
2.
3.
Faculty Liaison Will: Time Frame:
1.
2.
3.
Additional Information:
4
Adapted from UCLA School of Social Work Corrective Action Plan courtesy of Joseph Nunn, Ph. D
Consequences for Continued Unsatisfactory Performance:
1.
2.
3.
4.
Next Review Date: _________________________________
I have participated in the development of this Corrective Action Plan and understand my responsibility in meeting
its objectives as well as the consequences for continued unsatisfactory performance.
Student Signature Date
Field Instructor Signature Date
Faculty Liaison Signature Date
Field Coordinator Signature Date
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Completed 28 May 2020

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