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INITIAL PERFORMANCE VALIDATION: END OF ASSESSORS’ INITIALS & SIGNATURES
Validation Methods:
SELF ASSESSMENT
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
**
Participates effectively with the
interdisciplinary team to care for
patients drawing on resources
appropriately.
Supports organizational goals though
words and actions [ex. living the
Piedmont Promise].
RESOURCE MANAGEMENT:
Appropriately prepares and utilizes
supplies and resources for patient
care.
Completes documentation in real
time within the allotted shift hours.

II. UNIT SPECIFIC SKILLS (Hospital Specific )
EQUIPMENT: Refer to Lippincott Procedures**
Automated Medication Dispensing
Machine
Assistive Devices (walker, cane, crutch
walking)**
Bedside Cardiac Monitor/ Portable
Monitor
Bladder Scanner**

Revised 081517 ** Levels: Novice/Beginner (B) Advanced Beginner (AB) Competent (C) Proficient (P) Expert (E) *AGE SPECIFIC & POPULATION SPECIFIC COMPETENCIES 8