Free Laboratory Competency Assessment Form Template
Laboratory Competency Assessment Form
Please fill out this form to evaluate and confirm the competency of laboratory personnel in performing essential tasks and procedures.
Laboratory Name
Date Completed
Staff Name
Assessor Name
Part A: Pre-analytic
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Meets Standard |
Does Not Meet Standard |
N/A |
Notes |
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|---|---|---|---|---|
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Sample Handling |
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Sample Storage |
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Laboratory Information Management System |
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Part B: Analytic
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Meets Standard |
Does Not Meet Standard |
N/A |
Notes |
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|---|---|---|---|---|
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Sample Preparation |
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Preventative maintenance logbook |
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Instrument maintenance |
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Function checks |
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Intermediate test results |
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Review and record test results |
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Part C: Post-analytic
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Meets Standard |
Does Not Meet Standard |
N/A |
Notes |
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|---|---|---|---|---|
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Peer Review |
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Final reporting of test results |
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Sample management |
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Test results documentation retention |
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Validation or exercise data |
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Quality improvement reports, case studies and/or scenarios |
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Problem solving demonstration or quiz |
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Overall Assessment
-
PASS
-
FAIL
Assessor Signature
Name:
Date:
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