For Chemstrip Products
Care Unit_______________ Date:__________ Time:_______
Name__________________________ SS#________________________
| Task | Y | N |
| Urine mixed before testing? | O | O |
| Dip and drain to remove excess urine? | O | O |
| Timed reactions for proper intervals? | O | O |
| Performed proper color interpretation? * | O | O |
| Tightly close the container? | O | O |
| Overall competent? | O | O |
*Note: if color interpretation is suspect, check employee for color blindness.
Evaluated by:_______________________________________
Comments/Corrective action:
Guidelines for evaluators:
Mixing: The employee should give the urine healthy swirl for several seconds or invert the container several times immediately before testing.
Dip and drain excess: The stick should be dipped compelely but briefly and removed by dragging the strip over the top of the container. This will drain off the excess urine. The strip must not be "blotted" on the reaction pads.
Timing: In general, all pads may be read at exactly 60 seconds (except urobilinogen (10-30 sec.) and leukocytes (2 min)) . Optimum times below:
* glucose and ketones- wait 60 seconds after dipping.
* urobilinogen- read 10-30 seconds after dipping.
* protein, blood and nitrite - read 30 to 60 seconds after dipping.
* leukocytes- wait two minutes.
Tightly close the cap on the container:This is self-explanatory but very important!