SECTION
C
30
Name of facility:
COMPETENCY CHECKLIST
Assure® Platinum Blood Glucose Monitoring System:
Operator
Date
Trainer
The Trainer should observe the Operator performing the following tasks:
1. Select and prepare the fingerstick site correctly.
YES
NO
2. Use lancet/lancing device correctly.
YES
NO
3. Insert test strip into meter correctly.
YES
NO
4. Apply blood to sample application tip correctly.
YES
NO
5. Dispose of lancet correctly.
YES
NO
6. Identify when to repeat test or check result with a laboratory test.
YES
NO
7. Record result correctly.
YES
NO
8. Follow facility protocol for quality control testing.
YES
NO
9. Clean/disinfect meter correctly.
YES
NO
10. Change battery.
YES
NO
11. Additional Product Training
YES
NO
Did the Operator perform each task correctly? YES NO
If yes, the Operator is now certified to use the Assure Platinum Blood Glucose
Monitoring System. If no, retrain, perform tasks on list and document performance
on competency checklist again.
