Medication Administration Competency Checklist Date: Employee Name: Preceptor/Evaluator’s Name Competency: Medication Administration INDICATORS OF PERFORMANCE LEVEL SUMMARY O V T NA How Met Direct Observation/Return Demonstration Verbalization/Discussion Test Not applicable 1 2 3 Level of Competency Below expected standards Fully meets standards Well above standards.. The employee demonstrates skills and competence in the following: How Met Level of Competency 1 2 3 Evaluated by: Reviewed “ ” policy PHAR-940-211, NUR-804-019, PHAR-740-729 1..
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