CCP Audit: Submit Record of Professional Learning

To complete all the fields below, please follow these steps:

Complete all fields in the ‘Personal Information’ section.
Enter the date you completed your professional or learning activity. This will appear differently depending on your web browser. You can either type in the date using the format shown or click on the arrow next to the box and selecting your date from the pop-up menu.
Type in a description of your activity. Note: It might be best to write this in advance and simply copy/paste it into the field.
Click the button next to Yes or No for whether you received a certificate of attendance.
Type in a description of the knowledge you gained from your learning.
Type in a description of how your learning will improve your nursing practice and/or client outcomes.
Type in a description of how you use this new knowledge to improve your practice and positively impact client outcomes.
Repeat the above steps for Professional or Learning Activity #2
Complete all remaining fields
Click Submit.

See examples of how to properly fill out the section below.

It is important to note employer mandated education and/or review of knowledge (i.e. CPR, WHMIS, lifts and transfers, etc.) are not considered acceptable learning goals because they are not specific to practical nursing because they also apply to a variety of non-nurse care providers.

Required fields indicated by an asterisk (*).

Personal Information

Name*:

Registration #*:

Email Address*:

Phone Number*:

Professional or Learning Activity #1

Completed between November 1, 2016 and October 31, 2017.

Date completed: All learning activities must fall within the above dates.

Professional or Learning:
Describe your activity

Did you receive a certificate of attendance or participation?
YesNo
A certificate of attendance is not required; however, if you have received one, keep it in your personal files. DO NOT send it to the College.

New knowledge:
Identify something specific that you learned by completing this activity.

Reflective evaluation of learning goal:
Describe how you use this new knowledge to improve your practice and positively impact client outcomes.

Professional or Learning Activity #2

Completed between November 1, 2016 and October 31, 2017.

Date completed: All learning activities must fall within the above dates.

Professional or Learning:
Describe your activity

New knowledge:
Identify something specific that you learned by completing this activity.

Reflective evaluation of learning goal:
Describe how you use this new knowledge to improve your practice and positively impact client outcomes.

Declaration and Signature

My electronic signature indicates the above information is accurate and true. I understand this information is reviewed by CLPNNS staff or designates & incomplete forms may be returned to me resulting in a delay in this time sensitive process & this questionnaire may be kept on file as confirmation of my participation in the CCP audit & I may be required, pursuant to the current LPN Act and Regulations, to perform additional self-assessments and/or complete and submit verification of additional learning at my own expense to meet the Continuing Competence Program requirements.

Name*:

Electronic signature*:
* I verify I am the CLPNNS member named above and submission of this document is considered my electronic signature.

Submit

Please type the characters and/or digits you see in the box below.