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Care Unit_______________ Date:__________ Time:_______

Name__________________________ SS#________________________
Task Y N
Obtain needed supplies? O O
Turn hemocue "on". Pull cuvette holder to loading position. "Ready" appears in display? O O
Cleanse finger with alcohol? O O
Perform fingerstick? O O
Ensure that no blood is sucked from cuvette. O O
Place filled cuvette in holder and push into measuring position within 40 seconds of sampling?. O O
Read results (15-240 seconds)? O O
Overall competent?  O O


Evaluated by:_______________________________________

Comments/Corrective action: