Trainee Support Reporting Form - to be completed and submitted by the Education Programme Director of the employing organisation

This online reporting form should only be completed once appendix 6 of the HEE Trainee Support Guide has been completed and retained to ensure trainee consent has been obtained. Please tick the following box to confirm this.

I confirm appendix 6 has been completed and retained for trainee consent.
Yes
Trainee Forename
Trainee Surname
Trainee Email address

If your organisation is not listed on the dropdown above, please enter below.

Organisation Other
Name of Educational Supervisor
Educational Supervisor Email

Please indicate the support required from HEE selecting from the options below.

Education Programme Director confirmation of submission

EPD Forename
EPD Surname
EPD Email

Anything that is disclosed through this form is deemed confidential, however HEE LaSE Pharmacy staff reserve the right to report further any illegal activities or patient safety issues.

Please refer to the HEE privacy notice https://hee.nhs.uk/about/privacy-notice for information on how HEE manage your data.