SECTION
E
27
Instructor Name (Print) Operator/Trainee Name (Print) Date
Instructor Name (Signature) Operator/Trainee Name (Signature) Date
OperatorCertied Yes No Next In-service (Month/Year)
Name of facility:
IN-SERVICE TRAINING AND CERTIFICATION
ASSURE
®
PRISMMULTIBLOODGLUCOSEMONITORINGSYSTEM
Certied Instructor: Before signing checklist, the trainee must meet objectives listed below.
1. Familiarization with components of the Assure® Prism multi Blood Glucose
Monitoring System:
Meter
Features (strip release
button, test strip port, etc.)
Serial Number
Storage
Cleaning and Disinfecting
Toll-free Customer
Service Number
Test Strips
LotNumber
Expiration Date
Storage
Control Solution Range
Proper Strip Insertion
Handling
Control Solutions
Expiration Date
Acceptable Range
Test Procedure
Safety Lancets
Usage / Activation*
Disposal
*Actual blood sampling is not required.
2. Describe/Demonstrate:
Initial Meter Set-Up Options
Audible Beep
Time Format
Date Format
Minneapolis, MN 55439 USA
TEL 800.818.8877
FAX 952.646.3110
www.arkrayusa.com