Hazardous Sterile Compounding Competency

• Conducted on

  Date

• Prepared by

• Location
  Address

Employee Name ___________________________________________________________________________

Hazardous Compounding Training/Competency Documentation

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

• Select date

  Date

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

• Select date

  Date

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

• Select date

  Date

Demonstrated Competency of Hazardous Compounding in Biological Safety Cabinet

• Demonstrated Competency of Use with Closed System Transfer Devices

  Date

Understands Proper Use of Perdox RTU for Hazardous Drug Decontamination

• Select date

  Date

Completion of HMTW Pharmacy Department Hazardous Sterile Preparation Exam

• Select date

  Date

Evaluator Review: Name ______________________________________________________

• Select date

  Date