Steris University
NAME:DATE:FACILITY: POSITION: IN-SERVICED BY: DATE: INITIAL COMPETENCY: ANNUAL COMPETENCY: Score:The purpose of this document is to aid in training users to safely and effectively use (Insert product name). This document may also be used for periodic demonstration of an operator’s competencies in using (Insert product name). Documents referenced in this checklist include: (Select: Operator Manual (OM), Operation Guide (OG) or Instructions For Use (IFU)), (list other documents referenced in the checklist), representative guidelines, standards and facility-specific procedures as referenced petency for (Insert product name)Doc. Ref.User DemonstrationMain title/task is Arial 10 Bold fontSub title or section is Arial 10 Bold ItalicizedArial 10 plain textArial 10 plain textArial 10 plain text Comments: Acknowledgement of Review: CS Manager/Supervisor/Educator Signature __________________________________Employee Signature _________________________________________References:(Include references such as AAMI, AORN or SGNA standards for example) ................
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