Sign-off template - South West Peninsula Deanery

Evidence required for 5.1 Attainment of F1 Competency for Sign-Off 2009
Peninsula Foundation School
Trainee Name Trust √/X
1 12 months F1 experience in approved posts,
working in the full role to which appointed
2 Record of Sick Leave* Meets GMC requirements
3 Attendance at formal teaching sessions** Meets Deanery rules of 70%
4 Educational Supervisor report Satisfactory end of placement review forms (3) OR
5 Assessment requirements Mini CEX (6) with satisfactory results
6 DOPS (6) with satisfactory results
7 CbD (6) with satisfactory results
8 Mini-PAT (2) with satisfactory results
1 st 2 completed satisfactorily with confirmation from ES of no o/s problems
9 Satisfactory clinical supervisor reports (3) OR
1 st 2 completed satisfactorily with confirmation from CS of no o/s problems
10 Up to date portfolio Contains a recent PDP, evidence of reflective practice and self-appraisal of
learning. Must include evidence for all required practical skills
11 Summary of evidence Completed
12 Statement of Health and Probity Signed by trainee
CHECKED BY
Satisfactory evidence of competences
Name:
Title:
Signature:
Date:
signing off march 09 v4.doc

Please note that the 5.1 document should not be signed and dated any earlier than the 7 th July 2009.
If all items are passed, proceed to sign-off and give the completed document 5.1 (which must be counter-signed by the Head of
Peninsula Foundation School) to the trainee, send a copy to the foundation school and take a copy for the Trust.
A copy of the completed checklist must also be returned to the Foundation School.
If not all items are passed,
a) Return portfolio to trainee if items have not been presented and reconsider portfolio when these are done. A deadline for resubmission
should be set. Trainee should be advised that any delay in the signing-off process may result in them failing to
be registered in time to take up an F2 post at the expected start date.
b) Refer to Head of Peninsula Foundation School if item is failed i.e. the trainee has not completed satisfactorily the required
number of assessments (including clinical supervisor reports), educational supervisor reports are unsatisfactory, 70%
attendance record has not been achieved, the competences have not been met AND/OR there are other failed items relating
to the GMC and New Doctor requirements.
c) If 70% attendance has not been achieved, the trainee must submit a written explanation of their absences and evidence that
they have otherwise covered the missed topics.
Georgia Jones
Head of Peninsula Foundation School, South West Peninsula Deanery
March 2009
Notes
*Item 2 Record of Sick Leave: The maximum permitted sick leave is four weeks from the year as a whole.
**Item 3 Attendance at formal teaching sessions: If attendance at teaching is less than 70%, the trainee must submit a written
explanation of their absences and evidence that they have otherwise covered the missed topics.
signing off march 09 v4.doc

Evidence required for 5.2 F2 Foundation Achievement of Competency Document (FACD) 2009
Peninsula Foundation School
Trainee Name Trust √/X
1 12 months F2 experience in approved posts,
working in the full role to which appointed
2 Record of Sick Leave* Meets Deanery requirements
3 Attendance at formal teaching sessions** Meets Deanery rules of 70%
4 Educational Supervisor report Satisfactory end of placement review forms (3) OR
5 Assessment requirements Mini CEX (6) with satisfactory results
6 DOPS (6) with satisfactory results
7 CbD (6) with satisfactory results
8 Mini-PAT (2) with satisfactory results
1 st 2 completed satisfactorily with confirmation from ES of no o/s problems
9 Satisfactory clinical supervisor reports (3) OR
1 st 2 completed satisfactorily with confirmation from CS of no o/s problems
10 Up to date portfolio Contains a recent PDP, evidence of reflective practice and self-appraisal of
learning.
11 Summary of evidence Completed
12 Statement of Health and Probity Signed by trainee
Satisfactory evidence of competences
CHECKED BY
Name:
Title:
Signature:
Date:
signing off march 09 v4.doc

Please note that the 5.2 document should not be signed and dated any earlier than the 7 th July 2009.
If all items are ticked, proceed to sign-off and give document 5.2 (which must be counter-signed by the Head of Peninsula
Foundation School) to the trainee, send a copy to the foundation school and take a copy for the Trust.
A copy of the completed checklist must also be returned to the foundation school.
If not all items are passed,
a) Return portfolio to trainee if items have not been presented and reconsider portfolio when these are done. A deadline for resubmission
should be set. Trainee should be advised that any delay in the signing-off process may result in them failing to
be able to take up higher training posts at the expected start date.
b) Refer to Head of Peninsula Foundation School if item is failed i.e. the trainee has not completed satisfactorily the required
number of assessments (including clinical supervisor reports), educational supervisor reports are unsatisfactory, 70%
attendance record has not been achieved, the competences have not been met AND/OR there are other failed items relating
to the Curriculum requirements.
c) If 70% attendance has not been achieved, the trainee must submit a written explanation of their absences and evidence that
they have otherwise covered the missed topics.
Georgia Jones
Head of Peninsula Foundation School, South West Peninsula Deanery
March 2009
Notes
*Item 2 Record of Sick Leave: The maximum permitted sick leave is four weeks from the year as a whole.
**Item 3 Attendance at formal teaching sessions: If attendance at teaching is less than 70%, the trainee must submit a written
explanation of their absences and evidence that they have otherwise covered the missed topics.
signing off march 09 v4.doc