Practice staff - please consider carefully whether this is an issue relating to student competence. If so it should be addressed via normal practice competency assessment strategy and in discussion with your PLT education representative.
In submitting this form you should be advised that the information provided may be disclosed to the individual concerned if requested or if used as the basis of an investigation
In submitting this form you are confirming that this is a true statement, to the best of your knowledge
Retention of data (DPA)
- Forms which do not lead to any action will have the same retention as the student file.
- If the raising of a concern results in Fitness to Practise hearing, your form will be retained as part of Fitness to Practise hearing paperwork.