Template · Chemistry

Competency Assessment Record

One employee, one test system, all six assessment methods. Fill it in on screen or print it blank. Suggested evidence is pre-filled for chemistry; change it to match your procedures.

Employee name

Position / credential

Laboratory / section

Test system / instrument

Assessment type

Assessment period

Six assessment methods

Each method must be assessed for each test system the employee performs, unless it doesn't apply. Record N/A with a reason.

Method	Evidence reviewed / observed	Date	Assessor	Result

Outcome

Overall result

Next assessment due

Remediation plan (if any): retraining, who, by when, how it will be reassessed

Employee signature / date

Assessor signature / date

Technical supervisor or consultant / date

Laboratory director or designee / date

Template provided by LabReady Pro. The six methods follow the CLIA competency assessment requirements (42 CFR 493.1413 and 493.1451). Confirm current requirements with your accrediting body's official materials; your laboratory director is responsible for approving competency content and assessors.