General Competence Assessment Form template
A form in the Personnel, Training and Competence procedure (PR12), mapped to ISO 15189:2022 clause 6.2. Fill it in whenever the task occurs. Used by the quality-management team.
FormISO 15189 · 6.2As needed
Calculated automaticallyRed = outside limits
Your LaboratoryGeneral Competence Assessment Form | YL-QM-FRM-12-F07a v1.0
Record: General Competence Assessment Form — October 2026
Employee NameR. Naidoo
Assessment Date2026-10-01
Designation / SectionMedical Technologist
Assessed byS. Dlamini
Assessment MethodDirect Observation
Assessment TypeInitial
| No. | Competency Statement / Task | Method (Obs/Oral/Written) | Result (Satisfactory / Unsatisfactory) | Score (1-5) | Evidence / Observation | Remediation Required? (Y/N) | Remediation Plan | Reassess Date | Assessor Sign |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Correctly identifies and greets patients/specimen sources | 5 | 92 | Within limits | Y | 2026-10-01 | |||
| 2 | Follows hand hygiene procedure before and after specimen handling | 5.06 | 64 | Y | 2026-10-08 | ||||
| 3 | Correctly labels and accessions specimens | 4.94 | 77 | Y | 2026-10-15 | ||||
| 4 | Identifies and processes urgent specimens appropriately | 5.04 | 88 | Within limits | N | 2026-10-22 | |||
| 5 | Operates assigned equipment according to SOP | 4.96 | 79 | Y | 2026-10-29 | ||||
| 6 | Runs IQC before patient testing | 5.04 | 97 | Y | 2026-11-05 | ||||
| 7 | Interprets IQC results and applies Westgard rules | 4.99 | 77 | Within limits | Y | 2026-11-12 | |||
| 8 | Troubleshoots IQC failures correctly | 5.09 | 66 | Y | 2026-11-19 | ||||
| 9 | Reports critical results within established TAT | 5.05 | 75 | Y | 2026-11-26 | ||||
| 10 | Applies result amendment procedure correctly | 4.94 | 62 | Within limits | Y | 2026-12-03 |
Overall Score77.70
Overall DecisionCompetent
… 7 more rows continue on the next page
Sign-off
| Role | Name | Signature | Date |
|---|---|---|---|
| Completed by | |||
| Reviewed by |
Shaded cells are calculated automatically. Values in red are outside their limits. † marks a corrected value (see Corrections).
Controlled document. Printed copies are uncontrolled unless stamped.Page 1
A4 landscape · first page · showing 10 of 17 rowsExactly as LabToolkit Pro prints it — with your logo and colours
What it records
- Competency Statement / Task
- Method (Obs/Oral/Written)
- Result (Satisfactory / Unsatisfactory)
- Score (1-5)
- Evidence / Observation
- Remediation Required? (Y/N)
- Remediation Plan
- Reassess Date
- Assessor Sign
Sign-off
- Completed by
- Reviewed by
Related templates
- Personnel File Checklist (PR12-F01)
- Personnel Orientation Checklist (PR12-F02)
- Code of Ethics, Impartiality & Confidentiality Declaration (PR12-F03)
- Personnel Training & Continuous Professional Development Plan (PR12-F04)
- Training Evaluation Form (PR12-F05)
- Competence Matrix (PR12-F06)
- Management System Training and Competence Form (PR12-F07b)
- Departmental Technical Training and Competency Assessment (template for F07c–F07i) (PR12-F07c)
- Competency Assessment Form (PR12-F08)
- Personnel Authorization Matrix (PR12-F09)
- Authorised Signatures & Initials Log (PR12-F10)
- Work Schedule (PR12-F11a)
- Departmental Duty Roster (PR12-F11b)
- On-call Roster (PR12-F11c)
- Personnel Replacement Form (PR12-F12)
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.