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INITIAL PERFORMANCE VALIDATION: END OF ASSESSORS’ INITIALS & SIGNATURES
SELF ASSESSMENT Validation Methods: ORIENTATION
SKILLS / TASKS and/or VALIDATION O = Observed performance SELF ASSESSMENT _________ _____________________________
PROCEDURES and/or D = Skills Lab demo/ VALIDATION _________ _____________________________
performance
EQUIPMENT Date: _______________ L = Learning assessment
form/Test Date: ________ _________ _____________________________
C = Chart review
V = Verbalized _________ _____________________________
Check 1 column below: PR = Policy Review Check 1 column:
N/A = Not applicable or no
opportunity at the facility
Date Met &
Assessor Initials:
Can Need Never Validation Task completed or Can Do Need COMMENTS:
Do Review done Methods: Procedure Review Needs Review?
Performed
Correctly
**

I. CORE SKILLS
PATIENT ASSESSMENT:
Completes emergency nursing
assessments and reassessments,
based on patient acuity,
developmental stage and disposition.
Completes pain assessment &
reassessment within defined time
frame and patients’ condition.
Assesses accurately a patient’s risk for
falling using the required assessment
tool.
CARE OF THE PATIENT:
Demonstrates protection of safety for
patients, families, coworkers and all
people at facility using the current
methods recommended [ex. ALWAYS
SAFE, responses to various CODEs
announced].
Demonstrates effective clinical
knowledge to guide critical thinking
and clinical decision making using best
evidence, best practices, and
Revised 081517 ** Levels: Novice/Beginner (B) Advanced Beginner (AB) Competent (C) Proficient (P) Expert (E) *AGE SPECIFIC & POPULATION SPECIFIC COMPETENCIES 4