Supervision Feedback Sheet
Directions:
Please place a hashmark on the line which most
closely measures your degree of satisfaction with the indicator. The far left
is 0% and the far right is 100%. The middle of the line would be 50%. Complete
this feedback sheet as soon as you are able after the meeting. Bring it for
discussion at the next subsequent meeting.
Date of the
meeting_________________________________
1. I had an opportunity to talk about what I
wanted to talk about.
[__________________________________________________________________________]
0 10
2. I felt understood.
[__________________________________________________________________________]
0 10
3. I was able to clarify my thoughts and feelings
about the topics under discussion.
[__________________________________________________________________________]
0 10
4. As a result of the discussion I gained in
confidence in my own functioning.
[__________________________________________________________________________]
0
10
5. As a result of the discussion I gained in
confidence in my purpose in working with the cases and situations reviewed.
[__________________________________________________________________________]
0 10
6. I was able to generate and/or obtain new ideas
about how to proceed.
[__________________________________________________________________________]
0 10
7. As the meeting unfolded I felt I could trust
the process and be more self disclosing.
[__________________________________________________________________________]
0 10
8. The things discussed were relevant and useful.
[__________________________________________________________________________]
0 10
9. A couple of things I got out of the meeting
are:
1.
2,
10. A couple of things I would change in future
meetings to improve the experience are:
1.
2.
11. Please prioritize the benefits below from 1 =
most important to 3 = lesser importance.
____
Personal and professional support for my work.
_____
It helped me know better what to do or not to do in my work to facilitate
better outcomes.
_____
It helped me grow in my professional knowledge and skills.
_____
Other -
12. The time and effort to reflect and provide
feedback on this supervisory process is worth it.
[__________________________________________________________________________]
0 10
13. I would like the feedback process to continue
to be part of our meetings.
[__________________________________________________________________________]
0 10
14. Some questions I would like added to this
feedback sheet are:
15. Questions which can be deleted from this
feedback sheet are: (list numbers)
