Wet Mount Proficiency Test 2015B

Scoring Sheet

Item / Expected Result / Your Result / Score
1 / Clue Cell / Correct □ Incorrect □
2 / Pseudohyphae / Correct □ Incorrect □
3 / Trichomonas / Correct □ Incorrect □
4 / White blood cell(s) / Correct □ Incorrect □
5 / Artifact / Correct □ Incorrect □
6 / Yeast / Correct □ Incorrect □
7 / Sperm / Correct □ Incorrect □
8 / Squamous Epithelial / Correct □ Incorrect □
9 / Bacteria / Correct □ Incorrect □
10 / Red blood cell(s) / Correct □ Incorrect □

_____ of 9 Correct ______% Successful Performance □Unsuccessful Performance □

******************************************************************************************* Interpretation of Results:

10/10 Correct (100%) - Successful performance. No corrective action required. Review results with all testing personnel. Document the review by having all testing staff sign the score sheet.

9/10 Correct (90%) – Successful performance. Corrective action required for incorrect result. Review results with all testing personnel, concentrating on the characteristics of the incorrect item. Corrective action must be documented by completing RLF.07(Corrective Action Form for Unacceptable Proficiency Test)Document the review by having all testing staff sign the score sheet.

Less than 8/10 Correct (0- 79%) – Unsuccessful performance. Corrective action required for incorrect results. Interpretation criteria for all incorrect responses must be reviewed with staff. The laboratory director is to determine if retraining of laboratory staff is required or if testing must be suspended until corrective action has been taken and proven to be effective. Consultation with your assigned technical consultant is advised. Corrective action must be documented by completing RLF.07(Corrective Action Form for Unacceptable Proficiency Test)Document the review by having all testing staff sign the score sheet.

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Scored by: ______Date: ______

Laboratory Director: ______Date: ______

Testing Staff Review: ______Date: ______

______Date: ______

______Date: ______