Revalidation-forms

Please log in to submit CPD entries.

Please log in to submit your practice hours.

Practice Related Feedback

Guide to completing a feedback log

Examples of sources of feedback

Patients or service users
Colleagues – nurses, midwives, nursing associates, other healthcare professionals
Students
Annual appraisal
Team performance reports
Serious event reviews

Examples of types of feedback

Verbal
Letter or card
Survey
Report

Please provide the following information for each of your five pieces of feedback.
You should not record any information that might identify an individual, whether that individual is alive or deceased. The section on non-identifiable information in How to revalidate with the NMC provides guidance on how to make sure that your notes do not contain any information that might identify an individual.

You might want to think about how your feedback relates to the Code, and how it could be used in your reflective accounts.

Date	Source	Type	Content of feedback

Your Practice Related Feedback submissions are private. View entries HERE.

You must be logged in to submit reflections.

REFLECTIVE DISCUSSION FORM

You must use this form to record your reflective discussion with another NMC-registered nurse or midwife about your five written reflective accounts.

To be completed by the nurse or midwife:

Name:
NMC Pin:

To be completed by the nurse or midwife with whom you had the discussion:

Name:
NMC Pin:
Email address:
Professional address:
Date of discussion:
Short summary:	had a discussion aout stuff
Contact number:

Declaration

I confirm I have completed a reflective discussion.

Signature

Date

Your reflective discussion is private and visible only to you when logged in. You can view your reflective entries HERE

Your Confirmation form submission is private. View entries HERE.

	A line manager who is also an NMC-registered nurse, midwife or nursing associate
	A line manager who is not an NMC-registered nurse, midwife or nursing associate
	Another NMC-registered nurse, midwife or nursing associate
	A regulated healthcare professional
	An overseas regulated healthcare professional
	Other professional in accordance with the NMC’s online confirmation tool

Name:
NMC Pin:
Date of last renewal of registration or joined the register:

Name:
Job title:
Email address:
Professional address including postcode:
Contact number:
Date of confirmation discussion:

Profession:
Registration number for regulatory body (if relevant):

	You have seen written evidence that satisfies you that the nurse, midwife or nursing associate has undertaken 35 hours of CPD relevant to their practice
	You have seen evidence that at least 20 of the 35 hours include participatory learning
	You have seen accurate records of the CPD undertaken.

I confirm that I have read Information for confirmers, and that the above named NMC-registered nurse, midwife or nursing associate has demonstrated to me that they have met all of the NMC revalidation requirements listed above during the three years since their registration was last renewed or they joined the register as set out in Information for confirmers. I agree to be contacted by the NMC to provide further information if necessary for verification purposes. I am aware that if I do not respond to a request for verification information I may put the nurse, midwife or nursing associate’s registration application at risk.
Signature:
Date: