Arkray Assure PRISM MULTI - Competency Checklist

SECTION
E
28
Name of facility:
COMPETENCY CHECKLIST
ASSURE
®
PRISM MULTI BLOOD GLUCOSE MONITORING SYSTEM
CertiedOperator
Date
CertiedTrainer
TheCertiedTrainershouldobservetheOperatorperformingthefollowingtasks:
1. Follow facility protocol for quality control testing. YES NO
2. Change battery. YES NO
 3. Selectandpreparethengersticksitecorrectly. YES NO
4. Use lancet/lancing device correctly.* YES NO
5. Dispose of lancet correctly. YES NO
6. Insert test strip into meter correctly. YES NO
7. Apply blood to sample-application tip correctly. YES NO
8. Record result correctly. YES NO
9. Identify when to repeat test or check result with a laboratory test. YES NO
10. Perform control solution test correctly. YES NO
11. Saving control solution test correctly. YES NO
12. Clean/disinfect meter correctly. YES NO
* Actual blood sampling is not required.
Did the Operator perform each task correctly? YES NO
Ifyes,theOperatorisnowcertiedtousetheAssure ® Prism multi Blood Glucose
Monitoring System. If no, retrain and perform tasks again.
Minneapolis, MN 55439 USA
TEL 800.818.8877
FAX 952.646.3110
www.arkrayusa.com