Welch Allyn REF 29400 - Manual (Page 21)

Welch Allyn OAE Hearing Screener Directions for Use 705353 Rev E
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Welch Allyn OAE Hearing Screener Clinical Competency Evaluation
Purpose: This evaluation certifies that _________________ has met Welch
Allyn’s requirements for utilizing the OAE Hearing Screener. The training
involved hands-on exercises. Although further training may be needed, this
individual has demonstrated competency in the following areas at this time.
TASK Performed Task Needed Training Did Not
Observe
1) Properly plugs in equipment _______ _______ _______
2) Properly turns on equipment _______ _______ _______
3) Powers on label printer _______ _______ _______
4) Demonstrates how to clean probe _______ _______ _______
5) Follows facility infection control _______ _______ _______
6) Launches Screener program _______ _______ _______
7) Records patient Log Number _______ _______ _______
8) Swaddles baby and/or prepares _______ _______ _______
patient for test
9) Selects patient's ear in software _______ _______ _______
10) Selects proper sized probe tip _______ _______ _______
11) Places probe into patient’s ear _______ _______ _______
12) Troubleshoots probe fit if needed _______ _______ _______
13) Knows how to View Details _______ _______ _______
14) Prints results from label printer _______ _______ _______
15) Restarts for next patient _______ _______ _______
16) Provides appropriate counseling to _______ _______ _______
patient or caregiver regarding results
17) Documents results according to _______ _______ _______
facility’s protoco l
The above evaluation was successfully completed on ___________________.
_______________________________
_______________________________
Name and Title of Person Supervising the Competency Evaluation