Catheter Competency Assessment Form
Evaluate healthcare staff's competency in catheter procedures using this structured assessment form.
Role of Assessee
*
Please Select
Registered Nurse
Licensed Practical Nurse
Nursing Assistant
Physician
Other
Demonstrates correct hand hygiene before catheter procedure
*
Yes, performed correctly
Partially performed
No, not performed
Select the correct equipment required for catheter insertion
*
Sterile gloves
Lubricant
Catheter of appropriate size
Antiseptic solution
Urine collection bag
Stethoscope
Other
Rate the technique of maintaining sterile field during procedure
*
1
2
3
4
5
Insert the catheter using proper technique
*
Correctly performed
Partially correct
Incorrect
Likert-scale: Confidence in recognizing catheter-related complications
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Understands signs of infection
1
2
3
4
5
Knows how to respond to blockage
6
7
8
9
10
Identifies leakage issues
11
12
13
14
15
Secures catheter and drainage system appropriately
*
Yes, secured correctly
Partially secured
No, not secured
Documents procedure accurately in medical records
*
Fully documented
Partially documented
Not documented
Rate overall adherence to infection control protocols
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Comments or observations (optional)
Submit Assessment
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