Title Page

  • Conducted on

  • Prepared by

  • Location

Employee Name ___________________________________________________________________________

Hazardous Compounding Training/Competency Documentation

Demonstrated Competency with Hand Hygiene, Gowning and Donning of Protective Garb for Hazardous Compounding

  • Select date

Demonstrated Sterile Compounding Competency with Completion of Media Fill and Gloved Finger Tip Samples

  • Select date

Demonstrated Competency of Manipulation of Hazardous Product with Completion of Fluorescein Chemo Test

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Demonstrated Competency of Hazardous Compounding in Biological Safety Cabinet

  • Demonstrated Competency of Use with Closed System Transfer Devices

Understands Proper Use of Perdox RTU for Hazardous Drug Decontamination

  • Select date

Completion of HMTW Pharmacy Department Hazardous Sterile Preparation Exam

  • Select date

Evaluator Review: Name ______________________________________________________

  • Select date

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