Templates & Activity Log

Practice Support Program (PSP) Templates

Step 1 – Assessment – Self-Reflective Assessment

Step 2 – Professional Development – Learning Objectives

Step 3 – Professional Development – Plan and Complete Activities

Step 4 – Professional Development – Evaluate Activities

Step 5 – Professional Development – QA Cycle Evaluation

Activity Logs

• Excel Version(Electronic Record) (Updated 2021 October version)

• PDF Version(Physical Record) (Updated 2023 July version)

• Video Instructions

The purpose of the Activity Log is to facilitate ensuring whether 50 CE hours have been achieved in the reporting period.

Samples of Completed Templates and Activity Log

• Sample 1 (Registrant “Joe”) – Step 2 , Step 3 , Step 4, Step 5
• Sample 2 (Registrant “Shelly”) – Step 1, Step 2, Step 3, Step 4, Step 5