Topical Medication Competency Checklist
Assessment and documentation of competency in the application of topical medications.
Participant Full Name
*
First Name
Last Name
Participant Role/Title
*
Assessor Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessment of Topical Medication Competency
*
Rows
Competent
Needs Improvement
Not Performed
Performs hand hygiene before procedure
1
2
3
Confirms patient identity
4
5
6
Checks medication order and expiry date
7
8
9
Selects correct medication and site
10
11
12
Applies gloves if required
13
14
15
Prepares skin/site appropriately
16
17
18
Applies medication using correct technique
19
20
21
Ensures patient comfort and safety
22
23
24
Disposes of used materials safely
25
26
27
Documents procedure accurately
28
29
30
Overall Competency Rating
*
Competent
Needs Improvement
Not Competent
Assessor Comments
Participant Comments (optional)
Assessor Signature
*
Submit Assessment
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