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Contents The forms and templates attached are examples of how a nurse or midwife may record how they meet the requirements of revalidation. Mandatory forms which must be used are marked below (M). These include real life examples taken from nurses or midwives who went through the revalidation pilot process. This pack includes a variety of reflective accounts designed to reflect multiple practice settings. 1. Practice hours log Independent sector - Senior nurse manager 2. CPD log Independent sector - Senior nurse manager 3. Practice-related feedback log 4. Reflective accounts form (M) - Independent sector – senior nurse manager x2 - Secondary care – NHS hospital nurse - Occupational health nurse 5. Reflective discussion form (M) Independent sector - Senior nurse manager 6. Confirmation form (M) Independent sector - Senior nurse manager 3 5 10 11 15 17 19 20 2 of 22 Guide to completing To record your hours o and/or midwife, please periods of practice. Pl practice first and then 450 hours. You do not individual practice hou practice hours in term weeks. For example if make one entry of hou of settings please set need to print additiona practice. If you are bo need to provide inform practice for each of th Dates: N a o 1.1.15 – current

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