Educational and supervisory decision aid

Developmental Supervision Record

Use observed behavior, reflection, and supervisory judgment. This tool has no numerical score and has not been validated as a psychometric measure.

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Record context

Name or local identifier

Date

Setting and assigned role

Supervised encounter

Learner

Supervisor

Date

Setting

Learner stage

Participant contact type

Responsibilities assigned

Responsibilities actually performed

Unexpected events

Consultations requested

Escalations performed

Areas of strong performance

Areas requiring coaching

Boundary observations

Countertransference or strong relational reactions discussed in supervision

Scope issues

Documentation quality

Response to feedback

Readiness for increased responsibility

Progression decision

Select the current decision

Remain at current stage

Increase selected responsibilities

Advance to next developmental stage

Add targeted supervision

Pause participant contact pending review

Return to an earlier level of responsibility temporarily

○ Remain at current stage ○ Increase selected responsibilities ○ Advance to next developmental stage ○ Add targeted supervision ○ Pause participant contact pending review ○ Return to an earlier level of responsibility temporarily

What does this learner need to demonstrate next?

Review date

All fitness instruments

By Mark Nicolas · Content updated September 23, 2026