Aseptic Technique Competency : Western Hospital Peripheral IV Cannulation (standard aseptic technique)

  • Staff Member

  • Select date

  • Assessors Name

Sample) Competency. *use to assess clinical competecy

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1. During the assessment, the assessor assigns a category corresponding to the performance level for each of the performance criteria (see below key)

2. If the performance falls into the category "NYC", comments must be included, comments are optional if category "C" is demonstrated/achieved

3. A digital copy of the completed assessment tool is provided for the clinician as well as filed in the health care worker's personnel file. (to provide a copy email result to the staff member's email address and copy to HR, if the staff member does not have email send a written request to HR to provide a printed copy).


  • C (Competent)
    Performance level: Standard of practice is at or above the performed criteria outlined
    Action required: Aspects of performance that are satisfactory are documented and positive feedback given to the clinician.

  • NYC (Not Yet Competent)
    Performance Level: Standard of practice is below the performance criteria outlined
    Action Required: All areas in which the standard of performance is below the criteria are discussed and documented through the use of examples of actual and expected practice. The clinician is provided with a learning program and times may be arranged for further practice so that the expected standard can be achieved within a prescribe timeframe.

Assessment Outcome

  • Performance Level Acheived

  • Comments:


  • Employee Name

  • Unit/Department

  • Assessor Name

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