UNIVERSITY OF SOUTH ALABAMA
DEPARTMENT OF RADIOLOGIC SCIENCES
IMAGING COMPENTENCY FORM
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Student Name
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Date
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Examination Performed
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Patient Number
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Affiliate
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Competency Grade
In order to pass a competency, the student must receive a minimum of 80 points, which is equal to a passing grade of 80%.
If a student does not receive this amount, the competency must be repeated. Regardless of pass or fail, please submit all
competency forms. The student must pass a minimum of six competencies during an imaging rotation (only one duplicate
competency will be allowed).
Directions: Select a number which describes the student’s performance in each of the following objectives (use whole
numbers only):
Rating Scale:
6
7
8
9
10
=
=
=
=
=
Poor (never performs objective)
Below Average (rarely performs objective)
Average (inconsistently performs objective)
Good (performs objective most of the time)
Superior (consistently performs objective)
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1.
Student properly evaluates request form and chart (if applicable), checks patient I.D. (armband or
address), and obtains and records all pertinent patient history.
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2.
Student provides a thorough explanation of the examination to be performed and handles patient
properly before, during, and after examination.
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3.
Student assures all necessary supplies are readily available to perform examination.
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4.
Student practices methods which assure patient safety at all times.
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5.
Student properly performs routine examination/procedure, and recognizes and corrects problems that
may exist.
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6.
Student properly manipulates equipment and demonstrates knowledge of its potential use.
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7.
Student properly labels all films (markers, positions, patient I.D., etc.).
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8.
Student concludes examination through proper processing of films/images and recognizes if any
additional films/images are necessary.
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9.
Student properly identifies anatomy related to examination performed.
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10.
Student demonstrates initiative, proficiency, and confidence throughout the procedure.
Comments:
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Evaluator’s Signature
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Date
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Student’s Signature
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Date
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Faculty’s Signature
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Date