| Name: | Roll No: | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Practicals(Student Lab.)/Practicals | ||||||||||
| S.No | Competency Addressed | Name of Activity | Date Completed(dd/mm/yy) | Attempt at Activity First or only(F)Repeat(R)Remedial(Re) | Rating Below(B)expectations Meets(M)expectations Exceeds(E)Expectations | Decision of faculty Completed(C)Repeat(R)Remedial(Re) | Initial of faculty | Verified Date | Verified By | Feedback received/Initial of learner |
| Certificate Skills | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| S.No | Competency Addressed | Name of Activity | Date Completed(dd/mm/yy) | Attempt at Activity First or only(F)Repeat(R)Remedial(Re) | Rating Below(B)expectations Meets(M)expectations Exceeds(E)Expectations | Decision of faculty Completed(C)Repeat(R)Remedial(Re) | Initial of faculty | Verified Date | Verified By | Feedback received/Initial of learner |
| Vertical Integration | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| S.No | Competency Addressed | Name of Activity | Date Completed(dd/mm/yy) | Attended (Yes/No) | Name of Faculty | Department | Submission of Reflection (Yes/No) | Initial of faculty | Verified Date | Verified By | Feedback received/Initial of learner |
| Early Clinical Exposure | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| S.No | Competency Addressed | Name of Activity | Date Completed(dd/mm/yy) | Attended | Submission of assignment(Yes/No) | Submission of Reflection(Yes/No) | Initial of faculty | Verified Date | Verified By | Feedback received/Initial of learner |
| Seminars | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| S.No | Competency Addressed | Name of Activity | Date Completed(dd/mm/yy) | Attended (Yes/No) | Presented | Rating Below(B)expectations Meets(M)expectations Exceeds(E)Expectations | Initial of faculty | Verified Date | Verified By | Feedback received/Initial of learner |
| Clinical Visit Departments | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| S.No | Competency Addressed | Name of Activity | Date Completed(dd/mm/yy) | Attended | Submission of reflections | Initial of faculty | Verified Date | Verified By | Feedback received/Initial of learner | |
| Self Directed Learning | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| S.No | Competency Addressed | Name of Activity | Date Completed(dd/mm/yy) | Attempt at Activity First or only(F)Repeat(R)Remedial(Re) | Rating Below(B)expectations Meets(M)expectations Exceeds(E)Expectations | Decision of faculty Completed(C)Repeat(R)Remedial(Re) | Initial of faculty | Verified Date | Verified By | Feedback received/Initial of learner |
| S.No | Date | Topic | What Happened | So What | What Next | Status | Verified Date | Verified By | Feedback received/Initial of learner |
