Tier Assessment Candidate name: Click or tap here to enter text.
Research Operations: Specimens Date: Click or tap here to enter text.

Candidate testing level: F ☐ S ☐ A ☐

Mode: Direct Observation

Competency / Fundamental / Skilled / Advanced
Collects, prepares, processes, ships, and maintains the inventory of research specimens for special samples (e.g., contagious specimens, international shipping, etc.). / Completes biohazard training. Employs basic specimen collection procedures per protocol. / Independently collects, processes and ships specimens per protocol, and according to all laboratory safety processes. / Performs at a skilled level and develops processes for specimen collection, handling or shipping. Demonstrates application of knowledge of specimens outside of individual job or assigned studies.

Check the box that applies to the observation you conducted with the candidate regarding specimen collection and preparation observation.

Yes No NA

Biohazard Training

Is biohazard training current? ☐ ☐ ☐

Is OESO biohazard shipping training current? ☐ ☐ ☐

Please mark the level of independence the candidate displays with the following tasks:

GUI-Performed with Guidance, IND – Performed Independently, NA – Not Applicable

GUI IND NA

Preparation

Did the candidate verify the patient’s identity? ☐ ☐ ☐

Did the candidate gather the materials, containers, and supplies needed? ☐ ☐ ☐

Did the candidate wash hands/wore gloves as appropriate? ☐ ☐ ☐

Collection

Did the candidate perform the collection using the proper techniques
and steps per protocol? ☐ ☐ ☐

Did the candidate perform the collection in the proper sequence? ☐ ☐ ☐

Did the candidate perform the necessary quality control procedures? ☐ ☐ ☐

Did the candidate prepare and label the specimen correctly? ☐ ☐ ☐

Did the candidate wear proper PPE during collection? ☐ ☐ ☐

Transportation or Shipment

Did the candidate store the samples appropriately (i.e. correct temperature)? ☐ ☐ ☐

Did the candidate pack the samples and ship the samples appropriately? ☐ ☐ ☐

Did the candidate transport the samples appropriately? ☐ ☐ ☐

Advanced Only: Describe your role in developing processes related to specimen collection, handling or shipping.

Click or tap here to enter text.

Advanced Only: Have the candidate describe any instances where s/he has demonstrated advanced application of knowledge and understanding specimens outside of his/her individual job or assigned studies. Some examples might include:

·  a description of difficult challenges s/he has met or helped others to address

·  providing mentorship to others outside of his/her team

·  developing and provided training to others, and/or

·  evidence that s/he is seen as a go-to resource for several faculty or staff

Click or tap here to enter text.

Evaluation Level

This documentation demonstrates:

☐ Fundamental Competency

☐ Skilled Competency

☐ Advanced Competency

Observer comments about candidate’s competency level: Click or tap here to enter text.

Observer Name (Print):

Observer Title (Print):

Observer Signature: Date:

Assessment – RO: Specimens - Page 3