D900 Competency Assessment Form 726444-A

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Name:

Ward:

Date:

Hospital/Department: Having completed this assessment, users will be able to demonstrate competency with the equipment to ensure correct application. Performance Criteria

Attained

Deferred Date

Signature of Assessor

Describe clinical application for the equipment Identify key components: ON/OFF switch Volume Control Headphone Socket Battery Low Indicator Probe Battery Compartment Speaker Demonstrate and perform: Removal of Probe Disconnect and reconnect probe from cable Remove and replace battery Using the headphones Demonstrate how to apply gel to the patient/probe Demonstrate how to hold the probe on the skin and at what angle Indicate why the unit may switch off automatically Show how the unit should be cleaned and stored after use Indicate the most fragile part of the probe and why it should not be dropped

Signature of Assessor:

Date:

Signature of Participant:

Date:

LIT 726444-A

Re-assessment Date:

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