Phlebotomy Competency Skills Checklist

Personal Information

Please fill the Recruiter Email correctly for successful application submission.

Candidate Name

Email of Recruiter / POC

Select Submission Date

SSN (Last 4 digits)

Proficiency Scale & Legend

1 No Experience

2 Need Training

3 Able to perform with supervision

4 Able to perform independently

Preparation

Introduces self to patient and explains blood tests have been ordered by physician.

Identifies the patient with two unique identifiers (armband, ask for name & DOB).

Compare patient ID information with barcode label.

Checks testing requirements (ie fasting).

Prepares supplies and tube selection.

Washes hand, don’s gloves.

Getting Started

Handling & Processing

Age Specific Competencies

Certifications

	Expiration Date
Resource location – Lab Test information Guide.
Blood Ethanol Collection – cleanse site with soap and water.
Blood Culture Collection Review.

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency.