Professional Documents
Culture Documents
Course Title:
Institution :
Instruction: Please check (√) the item below that best describes your opinion/[erce[tion of the cours
1 - Poor 3 - Good
2 - Fair 4 - Outstanding
CRITERIA
A. Obejectives
- Relevant to nursing practice
B. Course Content
-Topics relevant to I.V. Therapy
- Adequacy of course content
- Applicable to current I.V. Theapy practice
C. Resource Speaker
- Discusses the subject matter clearly
-Mastery of the subject matter
-Audience impact and audience participation
D. Knowledge of participants
- Knowledge before attending the course offering
- Knowledge after attending the course offering
- Can apply new knowledge, technique/skills to present job
E. Technical support/ assistance
- Training site / Venue
- Hand-outs
- Audio-visual materials and equipment
F. Practicum
- Objectives met
- Systemic conduction of return demonstration
- Time allotment
- Outstanding
1 2 3 4 REMARKS
ob
Evaluation Form
TOPIC: 1
A. Name of Mastery of Subject
IV Trainer Clarity
Preceptor
Speaker Use of Handouts and Visual Aids
Relevant to Experience/ Examples
Ability to establish Rapport
Time alloted
TOPIC: 1
A. Name of Mastery of Subject
IV Trainer Clarity
Preceptor
Use of Handouts and Visual Aids
Speaker
Relevant to Experience/ Examples
Ability to establish Rapport
Time alloted
TOPIC: 1
A. Name of Mastery of Subject
IV Trainer Clarity
Preceptor
Use of Handouts and Visual Aids
Speaker
Relevant to Experience/ Examples
Ability to establish Rapport
Time alloted
NOTE: Submission of this Evaluation Form duly accomplished to the IV Trainer/ IV Prog
issuance of the certificate of attendance.
2 3 4 5
2 3 4 5
2 3 4 5
Name of Hospital
Title of Program:
Date when Program was approved:
Date when Program was offered:
10
11
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19
IV THERAPY ATTENDANCE SHEET FORMAT
Address
Venue:
Address:
Name of Hospital
Title of Program:
Date when Program was approved:
Date when Program was offered:
Address
Venue:
Address:
APPROVED BY:
FINAL GRADE REMARKS
TOTAL GRADE
Trainer's Signature over Printed Name
Chief Nurse
IV THERAPY
Name of Hospital
10
11
12
13
14
15
16
17
18
19
20
21
IV THERAPY ATTENDANCE SHEET FORMAT
Address
Blood Components
PRC Number
Provider No.
Venue
License No.
License No.
Services
ed Name