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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
**
supplies/equipment.
Intraosseous Insertion:
Demonstrates proper insertion,
maintenance, and care of
intraosseous device (per Piedmont
policy and/or Lippincott procedure).
LifeLink:
Verbalizes criteria and guidelines for
Life Link notification.
Management of Behavioral
patients (1013/2013):
See Lippincott for reference to
manage manipulative patient, passive
aggressive patient, special nursing
OBS.
Recognizes escalating behaviors.
Practices safe de-escalation
techniques.
Demonstrates appropriate
documentation based on charting
guidelines.

Verbalizes difference between 1013 &

Revised 081517 ** Levels: Novice/Beginner (B) Advanced Beginner (AB) Competent (C) Proficient (P) Expert (E) *AGE SPECIFIC & POPULATION SPECIFIC COMPETENCIES 18