Facility:
Placement Dates:
Type of Placement ( e.g. Neuro/Rehab):
Please select appropriate degree:
Hours
Attended
(e.g. 40)
Dates Absent
Medical
Certificate
Provided
Supervisor's
Initials
Week 1
Week 2
Week 3
Week 4
Week 5
Date:
Date:
Rural Yes
Bachelor of Physiotherapy Acute - CR No
By sending in this form electronically (attached to your email) you are acknowledging that the student agrees with
this form. Therefore there is no need to sign and scan. You may give the printed version to the student.
In order to verify that students have attended the required hours, could you please initial in the appropriate space
below, for each week the student attends the placement
Each student needs to complete a minimum 35 hours per week for the Bachelor of Physiotherapy program and 32.5
hours per week for the Bachelor of Physiotherapy (Honours)
Please attach all Medical Certificates if provided
Name of Educator:
Name of Student:
Self Directed Learning (Public
holidays, Honours)
TOTAL HOURS
Student Attendance Record
Physiotherapy
Week Ending Date
0
Bachelor of Physiotherapy
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