Cdigo:

LISTA DE VERIFICACIN
ADT-FO-333-001

APOYO DIAGNOSTICO Y
TERAPUTICO
LABORATORIO CLNICO

Versin: 1

VERIFICACIN DE: _______________________________________________________________________

FECHA: _______________________
RESPONSABLE DE LA VERIFICACIN: _____________________________________________

ASPECTO

CUMPLE

NO
CUMPLE

OBSERVACIONES

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Puntaje obtenido
Menos de 60%
60-79%
80-91%
Mayor de 91%

PUNTAJE OBTENIDO

RESULTADO

No cumple
Cumple parcialmente
Satisfactorio
Excelente

Responsable de la verificacin: _______________________________________________

Cargo: ____________________________________________________________________

Responsable de la verificacin: _______________________________________________

Cargo: ____________________________________________________________________

Responsable de la actividad: ___________________________________________________________

Cargo: ___________________________________________________________________________

Responsable de la actividad: ___________________________________________________________

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Cdigo:

LISTA DE VERIFICACIN
ADT-FO-333-001

APOYO DIAGNOSTICO Y
TERAPUTICO
LABORATORIO CLNICO

Versin: 1

Cargo: ___________________________________________________________________________

OBSERVACIONES GENERALES
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OPORTUNIDADES DE MEJORA DETECTADAS:

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FECHA PROXIMA VERIFICACIN: _________________________________________________

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