COMPETENCY CHECKLIST (SAMPLE)
COMPETENCY CHECKLIST (SAMPLE)
Name:
Title: Unit:
|Skills Validation |
|Method of Evaluation: DO-Direct Observation VR-Verbal Response WE-Written Exam OT-Other |
|Emergency Code Standardization Process |Method of Evaluation |Initials |Comments |
|Patient Safety: | | | |
|Access to emergency code policy and procedure. |VR | | |
|Definitions of each emergency code. |WE | | |
|How to call each emergency code. |WE | | |
|When is it appropriate to call each code. |VR | | |
|Staff responsibilities after calling or hearing a code. |WE | | |
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Name of Person Validating the Skills:
Signature of Skills Validator: Date:
I received a copy of the Standardized Emergency Codes (Policy or Badge-Buddy).
I understand the Emergency Code procedures for the hospital and my role in patient safety.
I agree with this competency assessment.
I will contact my supervisor, manager or director if I require additional training in the future.
Employee Signature: Date:
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