<p> HN Unit Orthodontics – Log sheet tracking form</p><p>Tick and date as signed off by assessor</p><p>Fixed 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20</p><p>Fit 5 At least 2 cases with orthodontist De-bond 5 At least 2 cases with orthodontist Adjustment 20 At least 5 cases with orthodontist Removable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20</p><p>Active 5 At least 2 cases with orthodontist Passive 5 At least 2 cases with orthodontist Functional 10 At least 5 cases with orthodontist I can confirm that 50 log sheets have been completed successfully demonstrating competency in assisting in the above range of orthodontic procedures.</p><p>I can confirm that 50 log sheets have been completed successfully demonstrating competency in assisting in the above range of orthodontic procedures.</p><p>Candidate details & signature</p><p>Name & contact address Qualification (inc. GDC number Signature date)</p><p>Assessor’s details & signature</p><p>Name & contact address Qualification (inc. GDC number Signature date)</p><p>Log Sheet Supervising Registrants(s) </p><p>Name & contact address Professional Role GDC number Signature </p>