Clinical Supervision Documentation

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Please rate your supervisor/supervision experience on a scale from 1 to 5, with 1 being strongly disagree and 5 being strongly agree, for each of the following supervision tasks.


___ The environment was warm and inviting.

___ My supervisor took the time to learn about me.

___ I felt well informed about expectations including preparation for supervision sessions, communication, methods of supervision, use of technology, feedback, and evaluation.

___ I was informed about the structure and nature of future supervisory sessions.

___ My supervisor assessed my access to resources needed to be successful.

___ My supervisor assessed my knowledge and ability to practice basic skills and meet basic requirements to be successful.

___ I was provided ample opportunity to ask questions and received supportive answers and resources in response.

___ My supervisor and I collaboratively set goals for supervision both professionally and personally.

___ My supervisor reviewed the Code of Ethics.

___ My supervisor provided me with clear instruction regarding the security of client information, confidentiality, client files, and all materials utilized for documentation.

___ My supervisor reviewed informed consent and emphasized the importance of confidentiality, identifying myself as a “counselor-in-training,” and written consent for technology use.

___ My supervisor clearly reviewed an emergency plan for our supervisory time with specific steps and resources available to me in case of emergency situations to take care of myself and my clients.

___ I was provided with copies of all materials reviewed and all materials needed to successfully complete the supervision process.

___ My supervisor told me I had rights and how to proceed if I felt those rights were violated and provided resources.

___ I was provided with a supervisory contract and signed that I understood the expectations and requirements of supervision.


Supervisory Relationship

___ My supervisor was accessible to me.

___ My supervisor clearly delineated boundaries in a way that was protective for both of us.

___ I feel safe with my supervisor to openly discuss topics and concerns without fear of judgment.

___ My supervisor was open and initiated conversations regarding similarities and differences, multicultural issues, and diversity.

___ My supervisor listened to me and was willing to make adjustments when needed.

___ I felt comfortable discussing strengths and weaknesses of my knowledge, skills, and attitudes.

___ My supervisor cared about my development as a person and a professional.

___ My supervisor did not act as my counselor but would refer me for counseling if needed.

___ My supervisor made my client and me a priority in times of emergency.

___ I was empowered to meet challenges to grow, take risks, and develop during supervision.

Knowledge, Skills, and Attitudes

___ My supervisor was willing to demonstrate, role play, and assist in my learning process.

___ My supervisor reviewed materials with me in ways that were applied and meaningful.

___ There were conversations regarding beliefs, values, and attitudes that directly affected my counseling.

___ I was encouraged to explore my own theoretical orientation and to understand the application of theory in practice.

___ Case conceptualization was an integral part of the process prior to diagnosis or treatment.

___ I feel more knowledgeable and confident after supervision.

___ Conversations included generalizing material to other situations and environments for expanded learning.

___ I was expected to bring ideas, thoughts, opinions and questions to supervision sessions.

___ My supervisor shared his/her theoretical models for both therapy and supervision.

___ I felt that my supervisor cared for my clients and their well-being.



___ During orientation, I clearly understood by what means I would be evaluated and the structure of evaluation; I was provided with copies of evaluation forms.

___ I was given timely feedback regarding my performance and whether I was meeting expectations. ___ If there was an area of weakness identified, remedial resources were suggested with supportive and reasonable steps regarding expectations for improvement.

___ Verbal feedback was provided throughout my supervision.

___ I was given the opportunity to play an active role in my own supervision, evaluation, and development.

___ Evaluation caused me to feel more confident in my competence as a counselor.

___ I received both written and verbal formal evaluations during my supervision.

___ I felt comfortable discussing areas in need of improvement.

___ I valued my supervisor’s feedback and knowledge in difficult situations.

___ My supervisor initiated helpful conversations about my performance as a counselor and ways to improve.

___ My overall evaluation of my supervision experience was positive.


Adapted from Corey, Gerald; Haynes, Robert H.; Moulton, Patrice; Muratori, Michelle. 2020. Clinical Supervision in the Helping Professions. Wiley.


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