The evaluation checklist shall be completed and signed by the employee’s line manager as verification that all medication procedures have been followed in accordance with the Medication Procedure and related Work Instructions.

Name of person being evaluated
Name of person conducting the evaluation

Does the person correctly identify the person to be assisted by checking their name and photograph on their medication forms AND on their medication?

Does the person check the QF5301.02 Current Medication Summary Form to ensure it matches the medication named on the medication packaging?

Does the person position the patient appropriately to take or apply their medication. E.g. Sitting, standing etc.

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.