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1
Medication Administration Competency Checklist
Date:
Employee Name:
Preceptor/Evaluator’s Name
Competency:
Medication Administration
INDICATORS OF PERFORMANCE LEVEL SUMMARY
How Met
Level of Competency
O
Direct Observation/Return Demonstration
1
Below expected standards
V
Verbalization/Discussion
2
Fully meets standards
T
Test
3
Well above standards. May precept peers
NA
Not applicable
If overall performance or competency is rated below the minimum competency level of 2, that performance or competency
must be reassessed within 30 days of this review.
How
Met
Level of
Competency
1 2 3
Evaluated
by:
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