Competency Assessment Form
2 Pages
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Page 1
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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
Describe clinical application for the equipment Identify key components: ON/OFF switch Volume Control Headphone Socket Battery Low Indicator Probe Battery Compartment Speaker Gain/Mode Button Start/Stop Button Printer Socket LCD Display 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 When used continuously When left on
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Signature of Assessor
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Performance Criteria
Attained
Deferred Date
Signature of Assessor
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 Demonstrate the change in flow direction displayed by changing probe angle Demonstrate how to increase the sensitivity of the direc- tional flow arrows by changing the gain Demonstrate how to produce a printout when the unit is connected to the Dopplex Printa (if applicable) Demonstrate how to record a waveform using Dopplex Reporter software package (if applicable)
Signature of Assessor:
Date:
Signature of Participant:
Date:
LIT 726445-A
Re-assessment Date:
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