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RN/LPN Competency Check-Off
Phone: (248) 395-3777, Fax: (248) 395-3370,
www.hchs.com
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28000 Woodward Ave., Ste 100., Royal Oak, MI 48067
Select One:
New Employee Precept
Precept In Home/New Case
Annual Check-Off With Case Conference
Annual Check-Off Without Case Conference
Other
Other:
Preceptee Name:
Position:
LPN
RN
Client Name:
Client's Clinical Supervisor / Clinical Supervisor Involved:
Tammie Austin, RN
Mical Bey-Shelley, BSN, RN
Teresa Daniels, BSN. RN
Diane Danna, RN
Jeanie Kidd, BSN, RN
Tiffany Rickett, BSN, RN
Martha Shaver, RN, BS, MPA
Stephanie Rafe, MSN, RN
Preceptor Name:
Preceptor Position:
LPN
RN
Date of Orientation Shift:
+
Start Time:
Stop Time:
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