NURSING DEPARTMENT

SUMMARY COMPETENCY RECORD ONLINE 2 YEARS

HOSPITAL/CENTER:

KFMC/KSHC

UNIT/WARD/CLINIC/AREA: CSW

COMPETENCIES FOR CLINICAL POSITION: SN2

STAFF NAME:
POSITION:

(NM; HN; CN; SN1, 2, 3; PCA; HCA)

EMPL. NO:

Instructions: The Head Nurse is to ensure that the titles of required online competencies are relevant to the staff position are listed on the Summary and provide the staff the direction how to
access these online competencies. The Staff is to keep the Summary Competency Record and set of relevant individual competencies/certificates and to ensure the assessor completes their
details and initials on both the individual competency and the Summary. The Summary Competency Record and all individual competencies/certificates are to be submitted to the Head Nurse
before the Annual Performance Appraisal.
Competency Title

Date
Completed

Date
Completed

Date
Completed

Assessor

Comments
Name

Pos.

Empl.
No.

Medication Safety

April 17,

Competent

Rajeswari Jayaraj

CI

15490

Wound care

2016
April 17,

Competent

Rajeswari Jayaraj

CI

15490

SBAR

2016
April 17,

Competent

Rajeswari Jayaraj

CI

15490

Time Out

2016
April 18,

Competent

Rajeswari Jayaraj

CI

15490

Pathophysiology of Pain

2016
April 18,

Competent

Rajeswari Jayaraj

CI

15490

Physical Restraints

2016
April 19,

Competent

Rajeswari Jayaraj

CI

15490

Pressure Ulcer

2016
April 19,

Competent

Rajeswari Jayaraj

CI

15490

Fall Prevention and Management

2016
April 20,

Competent

Rajeswari Jayaraj

CI

15490

Palliative Care

2016
April 17,

Competent

Rajeswari Jayaraj

CI

15490

NS JN/ahr Unit Orientation Pack 21.10.2013 V2/Modified for Annual Performance Purposes

Initial
s

NURSING DEPARTMENT

Pain Assessment and Management

2016
April 18,

Competent

Rajeswari Jayaraj

CI

15490

Code stroke

2016
April 20,

Competent

Rajeswari Jayaraj

CI

15490

2016
Signatures:
Staff: Name:

Date:

Clinical Instructor: Name:

Date: .

Head Nurse: Name: . Date:

SUMMARY COMPETENCY RECORD ONLINE ANNUAL

HOSPITAL/CENTER:

KSHC

UNIT/WARD/CLINIC/AREA: CSW

COMPETENCIES FOR CLINICAL POSITION:

STAFF NAME:

(NM; HN; CN; SN1, 2, 3; PCA; HCA)

POSITION:

EMPL. NO:

Instructions: The Head Nurse is to ensure that the titles of required online competencies are relevant to the staff position are listed on the Summary and provide the staff the direction how to
access these online competencies. The Staff is to keep the Summary Competency Record and set of relevant individual competencies/certificates and to ensure the assessor completes their
details and initials on both the individual competency and the Summary. The Summary Competency Record and all individual competencies/certificates are to be submitted to the Head Nurse
before the Annual Performance Appraisal.
Competency Title

Date
Completed

Date
Completed

Date
Completed

Assessor

Comments
Name

Pos.

Empl.
No.

Hazardous Spill Management

April 20,

Competent

Rajeswari Jayaraj

CI

15490

Manual Handling

2016
April 18,

Competent

Rajeswari Jayaraj

CI

15490

Infection control

2016
April 26,

Competent

Rajeswari Jayaraj

CI

15490

Fire Response

2016
June 15,

Competent

Rajeswari Jayaraj

CI

15490

Initial
s

2016
NS JN/ahr Unit Orientation Pack 21.10.2013 V2/Modified for Annual Performance Purposes

NURSING DEPARTMENT

Environmental safety program

April 18,

Competent

Rajeswari Jayaraj

CI

15490

/disaster response
Information Security

2016
April 26,

Competent

Rajeswari Jayaraj

CI

15490

2016
Signatures:
Staff: Name:

Date:

Clinical Instructor: Name:

Date: .

Head Nurse: Name: . Date:

NS JN/ahr Unit Orientation Pack 21.10.2013 V2/Modified for Annual Performance Purposes