)2( ‫مــــجمع عيــــادات زهــــرة األمـــــل الطبي‬

Zahrat ALAmal Medical Polyclinics (2)

LABORATORY
COMPETENCY VALIDATION CHECKLIST
NAME: ________________________________________________ ID NO.: ______________

POSITION / DEPT: ________________________________ JOINING DATE: _________________

ASSESSMENT DATE: __________________________ Initial Competency Annual Evaluation

ASSESSOR: ________________________________ POSITION: _________________

COMPETENCY STATEMENT:
The participant demonstrates clinical knowledge, skill, and appropriate attitude in performing the task
independently without direct supervision.

% Unsatisfactor Not
KNOWLEDGE Satisfactory
y done
5% Infection control basic skills
5% When to perform hand hygiene (5 moments)
5% How to handle spills (chemical/biological)
5% Proper waste disposal
5% Sharp handling
5% Needle stick injury
5% PPE choice and use

% Unsatisfactor Not
SKILLS Satisfactory
y done
5% Performing hand hygiene
5% Donning PPE
5% Doffing PPE
5% Handling needle stick injuries
5% Handling waste delivery and sharp container delivery
5% Performing random audits on lab to check compliance

% Unsatisfactor Not
ATTITUDE Satisfactory
y done
5% Understanding risk of non-compliance
5% Always encouraging safe practices

FINAL OUTCOME:
GRADE OF COMPETENCY: (please encircle one)
Satisfactory 80 – 100 %
Need Improvement 60 – 79 %
Unsatisfactory < 60 %
 )2( ‫مــــجمع عيــــادات زهــــرة األمـــــل الطبي‬

Zahrat ALAmal Medical Polyclinics (2)

COMMENTS:

PRACTITIONER INFORMATION:

NAME: __________________________________________________ ID NUMBER:

____________________

POSITION / UNIT: _____________________________________ SIGNATURE:

_________________________
The above candidate has been verified as competent in all key elements of this competency by the following
assessor on specified date.

ASSESSOR INFORMATION:

NAME: __________________________________________________ ID NUMBER:

____________________

POSITION / UNIT: _____________________________________ SIGNATURE:

_________________________