UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

SCHOOL OF NURSING
Department of Community Health Systems
Masters Entry Program in Nursing
N150: Community Health Nursing
Spring 2010

ST U D E N T W E E K L Y C L I N I C A L E X P E R I E N C E L O G

Date Week Number

Student's Name Agency Name

Preceptor Name Clinical Instructor Name

The following documentation accurately reflects my clinical hours and activities for the week.

DATE TIME ACTIVITY Write the number(s) of the objective from

SPENT the Evaluation Sheet (This will help you
and your preceptor with your midterm and
final evaluations as well as help focus your
goals for the experience).

Total Hours This Week ______________Cumulative Hours to Date _______________

Clinical Instructor Signature _________________________ Date _________________

Student Signature __________________________ Date _________________

This form must he submitted weekly (on MOODLE). Use a running document that includes
the most recent subtotal of completed clinical hours. At the end of the quarter, please print
out one completed copy and sign it. Review with CI during final evaluation of the clinical
component of the course. This document will be maintained on campus.

N150Spring2010 syllabus updated 3/28/10 printed 3/30/2010 Page 28