It is the responsibility of the nurse whose license is on probation to ensure that the nurse's supervisor has the necessary standard forms that are required to be submitted to the Board in accordance with the conditions of the nurse's license probation.
Form 1 - Supervisor Verification Form available below is required to be completed as directed, signed and submitted directly to the Board by each of the nurse's supervisors only once in accordance with the requirements set forth in the nurse's consent agreement or Board Order.
Form 2 - Supervision Evaluation Form available below is required to be completed as directed, signed and submitted directly to the Board by the nurse's supervisors on a periodic basis as designated by, and in accordance with, the requirements set forth in the nurse's consent agreement or Board Order.
This information is provided by the Division of Health Professions Licensure within the Department of Public Health.
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