SECTION
E
25
Name of facility:
COMPETENCY CHECKLIST
Assure®
Prism multi
Blood Glucose Monitoring System
Operator
Date
Trainer
The Trainer should observe the Operator performing the following tasks:
1. Follow facility protocol for quality control testing.
n
YES
n
NO
2. Change battery.
n
YES
n
NO
3. Select and prepare the fingerstick site correctly.
n
YES
n
NO
4. Use lancet/lancing device correctly.*
n
YES
n
NO
5. Dispose of lancet correctly.
n
YES
n
NO
6. Insert test strip into meter correctly.
n
YES
n
NO
7. Apply blood to sample-application tip correctly.
n
YES
n
NO
8. Record result correctly.
n
YES
n
NO
9. Identify when to repeat test or check result with a laboratory test.
n
YES
n
NO
10. Perform control solution test correctly.
n
YES
n
NO
11. Save control solution test correctly.
n
YES
n
NO
12. Clean/disinfect meter correctly.
n
YES
n
NO
* Actual blood sampling is not required.
Did the Operator perform each task correctly?
n
YES
n
NO
If yes, the Operator is now certified to use the Assure Prism multi Blood Glucose
Monitoring System. If no, perform tasks on list and document performance on
competency checklist again.
Содержание Assure 530001
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