Nursing Competency Program Disaster Preparedness: Knowledge (Initial Each Element) CRN Title Date Remarks Signature

Kingdom of Saudi Arabia
Ministry Of Health
Jazan Health Directorate
Prince Mohammed Bin Nasser Hospital
Nursing Education & Staff Development
Nursing Competency Program

DISASTER PREPAREDNESS
Employee Name: __________________________ ID No. : ___________________________

Department/Unit: __________________________ Date of Joining: ____________________
Competency Start Date: _____________________
Competency Assessment Instructions – This Template must NOT be altered:

1. All ELEMENTS of the Competency (KSA) must be assessed by the patient bedside.
2. The Assessor is obliged to initial each element assessed and not √ - this happens in the first column.
3. The Remarks column should only be used to comment when the employee is unable to complete the element
being assessed. The Assessor is required to write a comment e.g. Needs more preparation and will be assed
again on the date and time”.
Competency Statement :
Ability to perform a specific role in preparing for and during a potential or declared Internal and /
or External DISASTER in area of practice. Indicate N/A for any competency elements not relevant to
area of practice.
CRN
Knowledge (initial each element) Title Date Remarks
Signature
1 Describe the difference between
----------- Internal and External DISASTER.
2 Verbalize actions to be taken in
----------- potential or declared DISASTERs
affecting the organization's
operations.
3 Differentiate actions to be taken in
----------- External and Internal DISASTERs.
4 Differentiate between different
----------- hospital codes and verbalizes actions
appropriate to each code.
5 Verbalize understanding of
----------- DISASTER Plan Activation
protocols and Chain of Command.
6 Identify location and objectives of
----------- facility specific control centers.
7 Verbalize understanding of actions
----------- undertaken by other units /
departments which specifically
impact area of practice during a
DISASTER.
8 Describe actions undertaken by all
----------- staff during a DISASTER –
including appropriate personal role.
Approved for Use in 26-June-18 NS Page 1

Ministry Of Health

9 Describe DISASTER triage and the

----------- main receiving areas – EMS, other
units as appropriate to area of
practice.
10 Describe how to register and
---------- document during a DISASTER for
both DISASTER victims and routine
patients.
11 Verbalize knowledge of staffing
--------- contingency plans / call-out
procedures during DISASTER
situations.
12 Differentiate actions to be taken out-
---------- of-hours, and during regular hours
when other key personnel are
present.
13 Verbalize actions to be taken to
---------- activate transport services for staff
during a DISASTER.
14 Discuss rationale and importance for
---------- a post DISASTER Critique.
CRN
Skills (initial each element) Title Date Remarks
Signature
1 Demonstrate ability to activate
---------- Internal DISASTER in area of
practice.
2 Complete the registration and

---------- document of both DISASTER
victims and routine patients during a
DISASTER.
3 Demonstrate the activation of

---------- staffing contingency plans / call-out
procedures during DISASTER
situations.
4 Complete the actions to be taken out-

---------- of-hours, and during regular hours
when other key personnel are
present.

Ministry Of Health

5 Participate in; in-service training,

---------- DISASTER drills, DISASTER
critiques.
6 Demonstrate ability to perform

---------- DISASTER roles appropriate to
usual position and back-up role (e.g.
Supervisor to Charge Nurse)
7 Demonstrate means of
---------- communication during a DISASTER.
8 Shows how to complete deactivation

---------- process when DISASTER called as
‘Code Green’ and how to facilitate a
debriefing session for staff.
9 Participates in a DISASTER
---------- Critique.
CRN
Attitude (initial each element) Title Date Remarks
Signature
1 Ability of Nurse to respond
---------- professionally and calmly in a
DISASTER situation.
2 Ability to facilitate activation and
---------- response in a DISASTER
situation.
3 Ability of Nurse to acknowledge
---------- limitations in knowledge and skills
in a DISASTER situation.
4 Ability to communicate with key
---------- personnel and respond to
instruction as relevant and
appropriate.
5 Demonstrate ability to organize
---------- and facilitate a Reflection session
in and on practice after a
DISASTER situation and activate
findings to improve future practice
and response.
Reference, Websites and Training Requirements:

Ministry Of Health

(These must be completed at least 1 month prior to the Competency Assessment. Policies must be
numbered with the Policy Title; Books referenced must state the specific Chapter for employee to read.)
Reference, Websites and Training
www.surfaid.org/‎
www.bt.cdc.gov/preparedness/
www.nhc.noaa.gov/prepare/ready.php
www.calhospitalprepare.org/
www.disaster-studies.ku.dk/‎
www.redcross.org/prepare
Specific Learning Performance Learning Strategies Comments for Follow-up

Opportunity Identified Expectations with Agreed with Deadline Learning Strategies and
Deadline Deadline Date/s
1. 1. 
2.
3.
4.
5.
Competency Completed by: ___________________________________

Designation: _______________________________________________
Date: _____________________
DATE COMPETENCY
NAME OF EMPLOYEE ID # SIGNATURE ASSESSMENT
COMPLETED
When completed, the Original must be given to the CRN who will collate the Compliance Rates for
the Unit and before sending it on to the Education Department. The Education Department will
collate the Compliance Rates for the Nursing Services Department. The Original is to be given to
the Employee for their Portfolio and a hard copy kept in the Employee’s Unit and Nursing
Department file.
Original – Employee for Portfolio

Copy held by Head Nurse/CRN in Unit
Copy held in Nursing/Education Department

Nursing Competency Program Disaster Preparedness: Knowledge (Initial Each Element) CRN Title Date Remarks Signature

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Nursing Competency Program Disaster Preparedness: Knowledge (Initial Each Element) CRN Title Date Remarks Signature

Uploaded by

Copyright:

Available Formats

Kingdom of Saudi Arabia

Nursing Education & Staff Development