IV Therapy Competency Post-Test Form
Complete this form to evaluate IV therapy competency following training. All responses will be reviewed for competency assessment.
Participant Name
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First Name
Last Name
Department/Unit
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Role or Job Title
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Trainer/Instructor Name
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Training Date
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Month
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Day
Year
Date
Post-Test Completion Date
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Month
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Day
Year
Date
Which of the following is a correct step in preparing an IV site?
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Cleanse the site with antiseptic solution using a circular motion
Insert the catheter before cleaning the skin
Do not wear gloves during insertion
Secure the catheter without checking for blood return
Select all signs and symptoms of IV infiltration.
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Swelling at the site
Coolness of skin around IV site
Redness and warmth
Patient reports pain or discomfort
Rate your practical IV insertion competency.
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Needs Improvement
1
2
3
4
Highly Competent
5
1 is Needs Improvement, 5 is Highly Competent
Please list any missed topics or provide comments related to IV therapy competency.
Post-Test Result
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Pass
Fail
Submit
Should be Empty: