Laser Treatment Competency Checklist Form
Complete this checklist to assess competency in essential areas of laser treatment procedures.
Name of Person Being Assessed
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Competency Assessment
*
Rows
Not Observed
Needs Improvement
Competent
Excellent
Reviews and follows safety protocols
1
2
3
4
Performs equipment checks and setup
5
6
7
8
Prepares patient and explains procedure
9
10
11
12
Executes laser treatment technique
13
14
15
16
Monitors patient response during procedure
17
18
19
20
Provides post-care instructions
21
22
23
24
Additional Comments or Observations
Assessor's Name
*
First Name
Last Name
Submit Checklist
Should be Empty: