CCP Audit Questionnaire

In this audit, the College will be verifying learning actives completed between November 1, 2015 to October 31, 2016 (2016 licensing year).

I received paper copies. Do in need to submit both the paper forms and the online form?
No, you can choose to submit either one (but not both). Online submission was developed to make this process easier for you.

Can I submit my learning plan or CLPNNS Certificate of Completion online as well?
Yes. Simply upload the electronic file (learning plan or certificate) from your personal computer and hit submit.

Can I submit the Record of Professional Learning (RPL) form online?
Yes. Simply type your responses directly into the online form and hit submit. Once submitted, you will receive a confirmation email with the information your added to the RPL form.  PLEASE NOTE: There is no save and send later function. Your data will be lost if you exit the form before sending it.

What if my learning activities fall outside these dates?
DO NOT complete this online form. Please call Jylene Simmons, Professional Practice Consultant at 902.423.8517 (ext. 4) or toll free in NS 1.800.718.8517 (ext. 4) to discuss next steps.

I still have some questions?
Call Jylene at the number above. You can also e-mail PracticeConsultant@clpnns.ca. Call or email early, do not wait until the last minute. More CCP resources can be found at http://clpnns.ca/ccp/.

How do I know if the documents were submitted?
If the submission is successful, the form will reset to blank and you will get a ‘Thank you for submitting” message at the very bottom (you have to scroll down) of the form. You will also receive a confirmation email.

Directions: Read the questions below in green. Answer either YES or NO by checking the corresponding box. Follow the instruction prompts.

Section 1: Employment

I worked less than 480 hours last licensing year due to medical/family leave.

    Yes - STOP: You may be exempt from the CCP Audit this year. Before going any further, please contact Jylene Simmons, Professional Practice Consultant at (902) 423-8517, option 4 (toll Free in Nova Scotia: 1-800-718-8517, option 4).
    (Exemption from this year does not guarantee you are exempt from the audit next year.)

No - Go to Section 2.

Section 2: Graduate Exclusion

I graduated from a PN program (cor or re-entry) or passed the CPNRE in the last 6 months.

    Yes - STOP: You may be exempt from the CCP Audit this year. Before going any further, please contact Jylene Simmons, Professional Practice Consultant at (902) 423-8517, option 4 (toll Free in Nova Scotia: 1-800-718-8517, option 4).
    (Exemption from this year does not guarantee you are exempt from the audit next year.)

No - Go to Section 3.

Section 3: Learning Document Submission

All activities MUST have been completed in the last licensing year (November 1, 2015 to October 31, 2016).

Section 4: 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 conifmration 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.

Required fields indicated by an asterisk (*).

Name*:

Registration #*:

Email Address*:

Electronic signature*:
* I verify that I am the CLPNNS member stated above and confirm that this counts as my electronic signature

Section 5: Record of Two Professional or Learning Activities

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.

Professional or Learning Activity #1

Completed between November 1, 2015 and October 31, 2016.

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 you learned by completing this activity.

Client outcomes:
How do you think this information will help you improve your nursing practice or client outcomes?

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, 2015 and October 31, 2016.

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 you learned by completing this activity.

Client outcomes:
How do you think this information will help you improve your nursing practice or client outcomes?

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


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