Laboratory Competency Assessment
Section: Clinical/Chemistry/Microbiology
Laboratory Name
Date Completed
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Staff Name
First Name
Last Name
Assessor Name
First Name
Last Name
Part A: Pre-analytic
Rows
Meets Standard
Does Not Meet Standard
N/A
Notes
Sample handling
1
2
3
Sample storage
4
5
6
Laboratory Information Management System (LIMS)
7
8
9
Part B: Analytic
Rows
Meets Standard
Does Not Meet Standard
N/A
Notes
Sample preparation
10
11
12
Preventative maintenance logbook
13
14
15
Instrument maintenance
16
17
18
Function checks
19
20
21
Intermediate test results
22
23
24
Review and record test results
25
26
27
Part C: Post-analytic
Rows
Meets Standard
Does Not Meet Standard
N/A
Notes
Peer review
28
29
30
Final reporting of test results
31
32
33
Sample management
34
35
36
Test results documentation retention
37
38
39
Validation or exercise data
40
41
42
Quality improvement reports, case studies and/or scenarios
43
44
45
Problem solving demonstration or quiz
Meets Standard
Does Not Meet Standard
N/A
Notes
Overall assessment
PASS
FAIL
Notes - Remediation Steps
Assessor Signature
Submit
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