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:
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