University of South Alabama
Department of Radiologic Sciences
Radiographic Competency Form
Student Name __________________________________
Date ______________________
Examination Performed __________________________
Patient #___________________
Method: Patient, Phantom, or Simulation (Circle One)
Evaluator’s Signature ___________________________
Pass - Fail (Circle one)
Student’s Signature _____________________________
Verifying Instructor_________
Competency Checklist: The competency checklist outlined below consists of numerous elements
grouped under six major headings which are considered to be important factors in performing a
radiographic examination. The evaluator must check only those elements a student fails to perform
during the competency examination. A student receiving more than 3 errors results in a failure of the
attempted competency.
Major Errors: A major error is defined as an error which would render the radiographic examination
useless for its intended purpose. A major error results in a failure of the attempted competency and the
evaluator must provide a brief explanation of the major error observed in the appropriate place on this
form.
Note: All of the elements listed below may not be applicable to all examinations.
I.
Equipment Manipulation (I. A.)
1. Manipulation of tube, table, control panel, etc. ______ 4. Alignment of tube to film ______
2. Assures all necessary equipment is available. ______ 5. Proper use of Bucky/cassette ______
3. Correct patient ID is visualized on film.
______ 6. Major Error ______
II.
Positioning (I. B.)
1. AP/PA ______ Cross-table ______
Obl.
______ Decubitus ______
Lat.
______ Upright
______
III.
Axial
______
Tangential ______
Other
______
2. Major Error
______
Axial
______
Tangential ______
Other
______
2. Part Measurement ______
Technique (I. C.)
1. AP/PA ______ Cross-table ______
Obl.
______ Decubitus ______
Lat.
______ Upright
______
3. Makes appropriate technique changes (% rules, etc.)
4. Major Error ______