Kingdom of Saudi Arabia

Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Microbiology Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations of routine patient test performance, including, as applicable, patient identification and preparation; and specimen collection, handling, processing and testing.

Position: 2. Monitoring the recording and reporting of test results, including, as applicable, reporting critical results
3. Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records
Date of Hire: 4. Direct observation of performance of instrument maintenance and function checks
5. Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples
Period of Evaluation: 6. Evaluation of problem-solving skills

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Bacteriology
Specimen processing
Blood Culture
Urine Culture
Stool Culture
CSF Culture
Swab Culture
Body Fluids Culture
Staining & Microscopy
Gram stain
Acid fast stain
Culture & Sensitivity
Aerobic cultures reading
Rapid ID Test
Streptococcal grouping
Automated ID system
Automated Susceptibility system
Manual Susceptibility
API Test
Anaerobic cultures reading
Direct Antigen Kit tests
Group A Streptococcus
Streptococcus pneumoniae
Meningitis Kit
Mycology (Yeast)
Specimen processing
KOH
culture
Automated yeast ID
Manual yeast ID
Mycobacteria
Specimen processing
AFB
Ziehel Nelseen Stain
Sending Samples to outside
Autoclave
Parasitology
Specimen processing
Trichrome stain
Modifide Ziehel Nelseen (MZN)
Macroscopic examination of faecal specimens
Microscopic examination of faecal specimens & Parasite
identification
H. pylori Ag in stool
Occult blood detection in stool.
Complete urine Analysis.
Automated UA
Giemsa stain/Malaria, blood parasites
Leishmania Skin Prepration
Direct Wet Prep
Concentrated Techniques Prep
Pregnancy Test
OTHER
APT (fetal hemoglobin test)
Semen analysis
Molecular Microbiology
Specimen processing
MRSA
CDIFF
CRE
VRE
MTB/RIF
Quality Assurance procedure
Quality Control
External Quality Control (Professioncy Test)
Machine/Equipments maintenance
Document & specimen archiving & retaintion

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-01 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Serology Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations of routine patient test performance, including, as applicable, patient identification and preparation; and specimen collection, handling, processing and testing.

Position: 2. Monitoring the recording and reporting of test results, including, as applicable, reporting critical results
3. Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records
Date of Hire: 4. Direct observation of performance of instrument maintenance and function checks
5. Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples
Period of Evaluation: 6. Evaluation of problem-solving skills

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Specimen processing
Serum/Plasma preparation
Dealing with oute side samples
Dealing with sending out samples
dealing quanti TB Samples
ELISA (Evolis)
Infectious diseases (HIV, HBV, HCV, HAV , HB Markers)
Dealing with HBV , HCV , HIV Positive Samples .
TORCH screening (IgM/IgG)
H. pylory Ab in serum
Other virus antibodies (TB, Varicella)
Autoantibodies (ds-DNA, ANCA, ANA, A.CCP, etc.)
Anti-cardiolipin (ACL) IgG/IgM
Agglutination Assays (Manual)
Widal test
Brucella test
RPR/VDRL
TPHA
Monospot
Nephlometry Assays (Immage 800)
CRP
IgG , IgM , IgA , IgE
ASO
RF
C3
C4
ROCHE Cobas e601 (Immunoassay)
hsCRP
HIV I/II Ag-Ab
HCV - Ab
Others (IgG, IgM, IGA)
Alinity
CMV IgM
CMV IgG
Toxo IgM
Toxo IgG
Rubella IgG
Allergy
Specific IgE pannels
Indirect Immunoflourecence (IIF)
ANA
anti-dsDNA
ASMA
AMA
Quality Assurance procedure
Quality Control
External Quality Control (Professioncy Test)
Machine/Equipments maintenance
Document & specimen archiving & retaintion

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-02 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Core Lab Type: ial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations of routine patient test performance, including, as applicable, patient identification and preparation; and specimen collection, handling, processing and testing.

Position: 2. Monitoring the recording and reporting of test results, including, as applicable, reporting critical results
3. Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records
Date of Hire: 4. Direct observation of performance of instrument maintenance and function checks
5. Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples
Period of Evaluation: 6. Evaluation of problem-solving skills

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Specimen processing
Plasma preparation
Serum preparation
Body fluid preparation (urine, CSF, pleural, etc.)
Hematology Section
Hematology Analyzer (Sysmex 9000N)
Hematology Diffrential (Sysmex 9000N)
Reticulocyte count (Sysmex 9000N)
Body fluid (Sysmex 9000N)
Coagulation Analyzer (STAGO)
Blood smear prepartion (Sysmex 9000N auto stainer /
Manual)
BM aspirate film satining (manual)
ESR (automated AliFax / Manual)
Sickle screening (Qualitative)
Clinical Chemistry Section
Routien Chemistry (Cobas 6000)
Special Chemistry (Cobas 6000)
Body fluid (Cobas 6000)
Immunoassay (Cobas e601)
Cardiac markers
Tumor markers
Hormonal assays
Quality Assurance procedure
Quality Control
External Quality Control (Professioncy Test)
Machine/Equipments maintenance
Document & specimen archiving & retaintion

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature
Re-training & re-assessment (use the reassessment
form)
Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-03 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Transfusion Medicine Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations of routine patient test performance, including, as applicable, patient identification and preparation; and specimen collection, handling, processing and testing.

Position: 2. Monitoring the recording and reporting of test results, including, as applicable, reporting critical results
3. Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records
Date of Hire: 4. Direct observation of performance of instrument maintenance and function checks
5. Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples
Period of Evaluation: 6. Evaluation of problem-solving skills

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Specimen processing
Cell suspension preparation
Serum preparation
ABO/Rh Typing
Tube
Gel card
Automated
Antibody Screen / ID
Tube
Gel card
Automated
DAT (IgG / C3)
Tube
Gel card
Automated
Miscellaneous Test Systems
Antibody Titer
Transfusion Reaction Work-up
Blood Products / Component Preparation
Receiving / Retyping Blood Products
Issuing Blood Products
Massive Transfusion Protocol
Thawing Plasma
Thaw/Pool Cryoppt
Aliquoting / Splitting units
Dealing with Irradiated Products
Quality Assurance procedure
Quality Control
External Quality Control (Professioncy Test)
Machine/Equipments maintenance
Document & specimen archiving & retaintion

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-04 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Blood Donation Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations of routine patient test performance, including, as applicable, patient identification and preparation; and specimen collection, handling, processing and testing.

Position: 2. Monitoring the recording and reporting of test results, including, as applicable, reporting critical results
3. Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records
Date of Hire: 4. Direct observation of performance of instrument maintenance and function checks
5. Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples
Period of Evaluation: 6. Evaluation of problem-solving skills

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Donor reception
Greet the donor
Provide donor education materials
Check donor eligibility on Hesn & HIS
Provide donor with DHQ
Donor selection
Review DHQ & donor consent
Donor interview
Donor health examination
Pre-donation procedure
Donor registeration on LIS
Check donor identification
Barcoding blood units & sample tubes
Blood donation procedure
Introduce yourself & explain the procedure
Prepare vein puncture site
Re-check donor identification
Start blood withdrawal process
Taking blood samples

Observe the donor throughout the donation process

Observe & manage adverse donor reaction
End donation process
Post-donation care
Ask the donor to stay seated or lie down for 5 minutes
before standing up
Encourage donor to drink fluids.

Provide donor with post-donation educational materials

Thank donor.
Collected units & samples preparation
Seal & quality check of collected bags
Transfer collected bags to component section
Prepare blood samples for sending
Quality Assurance procedure
Quality Control
Machine/Equipments maintenance
Document archiving & retaintion

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-05 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Histopathology Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations of routine patient test performance, including, as applicable, patient identification and preparation; and specimen collection, handling, processing and testing.

Position: 2. Monitoring the recording and reporting of test results, including, as applicable, reporting critical results
3. Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records
Date of Hire: 4. Direct observation of performance of instrument maintenance and function checks
5. Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples
Period of Evaluation: 6. Evaluation of problem-solving skills

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Grossing
Specimen processing
Grossing Room Technique
Decalcification
Post Grossing Processing
Processing Samples in Tissue Processor
Embedding on Sakura Tissue-Tek
Section Cutting
Cytology
Cytospin technique
Fine Needle Aspiration Cytology (FNAC)
Processing Samples for Cytologic Examination
Others
Using Automated Cover Slipper
Using Manual Cover Slipper
Preparation of Reagents
Frozen Section Procedure

Liquid Base Cytology (Gynecology/Nongynecology)

IHC
Preparing antibodies
Reagent preparation
Programing the antibody for samples
Machine operation (runing samples)
Post-staining techniques
Staining
Dako Special Stainer
Special Stains (Giemsa Stain)
Special Stains (Periodic Acid Schiff (PAS) stain)
Hematoxylin and Eosin staining
Special Stains (Diff-Quik Staining Procedure)
Quality Assurance procedure
Quality Control
External Quality Control (Professioncy Test)
Machine/Equipments maintenance
Document & specimen archiving & retaintion

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-06 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Section Head Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations.

Position: 3. Problem solving.

4. Performed.
Date of Hire: 5. Interview
6. Not applicable.
Period of Evaluation:

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Test Method Validation

Testing systems developed for each of the tests

performed in the laboratory provide quality laboratory
services for all aspects of test performance: preanalytical,
analytical and postanalytical.

Analytical Performance

Testing systems in use for each of the tests performed in

the laboratory provide quality laboratory services for all
aspects of test performance: preanalytical, analytical and
postanalytical.

Proficiency Testing

The laboratory is enrolled in a CAP-approved proficiency testing

program for all testing performed.

All proficiency testing samples are handled and tested as

required in respective policy & procedure.
Quality Control

Ensure that quality control and quality assessment programs are

established and maintained to assure the quality of laboratory
services provided and to identify quality failures as they occur.

Instrument Operation/Function Checks/Monitoring/Maintenance

Reviews instrument maintenance documentation
Staffing

Assist the Director with competency assessment of general

supervisors and testing personnel and assuring that the staff
maintain competency to perform test procedures and report test
results promptly, accurately and proficiently.

Policies and Procedures

Writes, reviews and updates SOPs
Quality Assurance
Provide QA reports (KPIs) monthly.
Safety

Ensure that the physical plan and environmental conditions of

the laboratory are appropriate for the testing performed and
provide a safe environment in which employees are protected
from physical, chemical and biological hazards.

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature
Re-training & re-assessment (use the reassessment
form)
Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-07 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Section Supervisor Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations.

Position: 3. Problem solving.

4. Performed.
Date of Hire: 5. Interview
6. Not applicable.
Period of Evaluation:

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Test Method Validation
Test method(s) selected can provide quality results for our
population.
Method validation(s) performed assess accuracy, precision,
linearity, etc., as required.
Laboratory personnel are performing tests according to
approved procedure.
Analytical Performance
Analytical test system performance levels are acceptable.

Corrective and appropriate remedial actions are taken when a

test system fails.
Patient test results are reported only when the system is
functioning properly.
Patient result reports include all required elements.
Proficiency Testing
Proficiency test results are submitted to the accrediting agency
by the deadline.

Proficiency test evaluations are reviewed and investigations

completed within established time frames.

Approved corrective action plans, if required, are followed.

Staff members review and understand proficiency testing results

and corrective actions.

Quality Control and Maintenance

QC data is reviewed at established intervals, according to
established protocols.
Maintenance data is reviewed at established intervals, according
to established protocols.
Staffing
Schedules staff according to workload
Prior to testing patient specimens, all personnel receive
appropriate training for the type and complexity of testing to be
performed.

Prior to testing patient specimens, ensure that all personnel

have documentation of passing training evaluation through
established assessment protocols.

Whenever necessary, needs for remedial training or contious

education are identified and such training is provided.

Policies and Procedures

An approved procedure manual is available to all personnel
responsible for any aspect of the testing process.

All procedures are reviewed biennially to ensure that all

information in them is current, accurate and reflective of current
practices.

Allocation of Resources
Keeps adequate inventory for tests performed
Quality Assurance

Data for Quality Assurance monitoring (KPIs) is provided to the

appropriate person according to the established timeframe.

Nonconformance Management
Investigates/documents nonconformances as required

Communicates critical information to management, as

appropriate

Performs/participates in root cause analysis, as needed

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature
Re-training & re-assessment (use the reassessment
form)
Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-08 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Clinical Pathologist / Histopathologist Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations.

Position: 3. Problem solving.

4. Performed.
Date of Hire: 5. Interview
6. Not applicable.
Period of Evaluation:

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Compliance with Laboratory Policies and Procedures
Complies with regulatory/accreditation requirements,
manufacturer’s instructions
Complies with institutional procedures
Communication
Properly communicate with staff.
Keeps Laboratory Administrator/Director informed.

Properly communicate with hospital HCWs as required.

Problem Solving
Analyzes causes of occurrences
Establishes plan of action to solve problems
Review of Quality Control
Understands, utilizes, and adheres to Laboratory Quality Control
processes per SOP
Reviews QC records
Implements corrective actions, as needed
LIS Knowledge/Abilities
Tracks specimens
Looks up test/patient information
Reviews pending log
Reviews/validates patient test results
Staff Training
Reviews SOPs with staff to ensure procedures are followed

Service Utilization
Monitor lab service utilization & report section head/lab director
monthly.
Safety

Ensures staff properly adhere to safety policies & perform/use

PPE, waste disposal & safe laboratory practices.

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-09 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Management Staff Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations.

Position: 3. Problem solving.

4. Performed.
Date of Hire: 5. Interview
6. Not applicable.
Period of Evaluation:

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Aknowledge and apply all APP and DPP.
Able to modify, update and verified DPP.
Able to order the inventory for reagent, equipment, supplies and
accessories
Able to Monthly check for instrument maintenance.
Able to Monthly check for instrument quality control.
Able to Monthly check for documentation in all area (critical log
sheet, rejected sample).

Able to follow up and verify external Quality Control specimen.

Able to check for the external QC sample results.

Communicate with all suppliers company.
Communicate with higher authorities (lab manger, lab
pathologists, hospital manager).
Arrange monthly rotation for all staff in every area
Arrange for lab staff vacations.
Ensure all personnel have documentation of required education
and experience.
Ensure that all staff are following the IPP and DPP
Evaluate all staff
Supervise any validation or revalidation project
Report attendances and punishment
Supervise and evaluate Training for new staff
Put the development plan and deadline.
Arrange for staff meeting
Collect and Perform lab statistics
Follow up Lab KPIs
Planning for staff continuous education
Participate in training, teaching, continues education,
competency test.

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-10 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Reception / Porter Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations.

Position: 3. Problem solving.

4. Performed.
Date of Hire: 5. Interview
6. Not applicable.
Period of Evaluation:

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Essential info for the test request form (paper or LIS).

Know the available test list in the department.

Know about acceptance and rejection criteria.
Know the different type of specimen received in the department
( CBC, Coagulation, body fluids).

know about the different tubes ( EDTA, Sodium citrate, etc…)

and the type of tests collected on these tubes.

Handling and Transport samples to laboratory sections

Handling and Transporting blood component units

know about the different requirement for transporting blood
components

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-11 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024 Copy No: 1 Page No: 1 / 1
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Phlebotomy Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations.

Position: 3. Problem solving.

4. Performed.
Date of Hire: 5. Interview
6. Not applicable.
Period of Evaluation:

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Greet patient.
Identify patient.
Explain procedure.
Select venipuncture site.
Assemble equipment.
Put on gloves.
Tie tourniquet.
Prepare puncture site.
Inspect needle for flaws.
Anchor vein.
Stretch skin taut.
Bevel up.
Needle properly anchored.
Puncture vein smoothly.
Collection tube inserted into holder.
Tube top punctured.
Specimens collected in a proper order.
Tubes removed from holder.
Invert tubes 4-5 times.
Tourniquet released.
Bluntable needle activated.
Needle withdrawn from vein properly.
Pressure applied to venipuncture site with gauze.
Dispose of needle.
Bandage applied if appropriate.
Tubes labeled with required information.
Tubes bagged for transport.
Remove gloves.
Wash hands.
Thank patient.
Transport specimens to laboratory.

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-12 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Microscopy Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations.

Position: 3. Problem solving.

4. Performed.
Date of Hire: 5. Interview
6. Not applicable.
Period of Evaluation:

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

General
Turning on /off the microscope
Turning on /off the Fluorecence lamp
Microscope maintenance & cleaning
Light microscopy (Hematology)
Peripheral blood examination
Bone marrow examination
Body fluid examination
Light microscopy (Parasitology)
Fecal specimen examination
Fecal parasite identification
Urine specimen examination
Urine parasite identification
Blood parasite identification
Leishmania identification
Vaginal specimen examination
Vaginal parasite identification
Flourecent Miscroscopy (Immunology)
ANA
AMA
ASMA
Anti-DNA ds
Light microscopy (Microbiology)
Gram stain
Acid fast stain
Semen examination
Light microscopy (Blood Bank)
FMH (Rosette test)
Light microscopy (Histopathology)
Different tissue histopathological examination
Cytological examination

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-13 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Flowcytometry Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name: 1. Direct observations of routine patient test performance, including, as applicable, patient identification and preparation; and specimen collection, handling, processing and
testing.
Position: 2. Monitoring the recording and reporting of test results, including, as applicable, reporting critical results
3. Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records
Date of Hire: 4. Direct observation of performance of instrument maintenance and function checks
5. Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples
Period of Evaluation: 6. Evaluation of problem-solving skills

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Pre-analysis

Assessment of blood film (with hematopathology supervision)

Assessment of sample adequacy/acceptance
Panel selection (with hematopathology supervision)
Sample Preparation
Staining (surface, cytoplasmic)
Washing
Dilution
Filteration
FCM services
Immunophenotyping for Leukemia and Lymphoma.
Lymphocyte subsets
Residual leucocytes for PRBCs units.
Residual leucocytes for Platelets units.
Data analysis
Selection of targted population
Proper gating on selected population
Sorting-out positive & negative cells
Post-analysis
Result entery
FCM machine set-up
8 color, one flow, CST set-up
7 color set-up
4 color compansation
Quality Assurance procedure
Quality Control
External Quality Control (Professioncy Test)
Machine/Equipments maintenance
Document & specimen archiving & retaintion

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-14 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Safety-IPC-LPH Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations.

Date of Hire: 3. Problem solving.

4. Performed.
Period of Evaluation: 5. Interview
6. Not applicable.
Evaluator(s):

Written Exam: S/N

TEST SYSTEM 1 2 3 4 5 6 S/N Comments
Disaster Management
All plans and protocols of External and Internal disasters.
Preparation Of Laboratory Evacution Plan
Application and Drills
Hand Hygien
Methods of hand washing-Hand Rubing
Importance Of hand hygiene
Gloves Technique
Types of gloves
when to waer and when to remove ?
Whre to dispose ?
Spill Managemnt
Types of spills
How to control spills based on Public health rules
location of spill kit
Safety Shower &Eye Wash
Location safety shower & eye wash
When to use ?
How to use ?
Waste Managemnet
Types of waste
Types of waste containers
New MOH waste guidelines
Sharps
Liquid waste
Chemical waste
Biological waste
Biological plates Disposals
Using Autoclaves
TB & airborne infections
PPE
N95
PAPR
Immunization & Vaccine
Emergency Information (Codes)
Knowing codes
explain the emergency situations
Fire safety
Fire prevention rules
Fire Extinguishers (Type and uses )
Emergency Exits
Assimply point
Evacution Plan
duty and responsibility in the evacation plan
where is the plane (location )?
Needle stick Injury and sharp injury (accidents )
Steps & Proceduer
how to report?
Latex allergy
knowleage and preventions
List
Chemical safety
general knowlage of Hazmat
location of chemical safety Cabeints
location of chemical spill kit and how to use?
SDS list
Potentially carcenogenic chemicals
PEL & STEL
Chemical waste (special waste)
UV and Radiation Safety
UV( eye glass protection) when to use ?
Radiation precautions if aplicable
Ergonomics Safety
Understading the concept
Application
Vaccination
All nessessary vaccins
S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.

Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.

Assessor's Signature: Date:

Recommendations
Action Items Date & Signature
Re-training & re-assessment (use the reassessment form)
Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-15 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Safety-IPC-LPH Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations.

Date of Hire: 3. Problem solving.

4. Performed.
Period of Evaluation: 5. Interview
6. Not applicable.
Evaluator(s):

Written Exam: S/N

TEST SYSTEM 1 2 3 4 5 6 S/N Comments
Disaster Management
All plans and protocols of External and Internal disasters
are explained
Preparation Of Laboratory Evacution Plan
Drills of Disasters is done
Hand Hygien
Monioring And Observation
Training all Staff
Reporting of All violations
Gloves Technique
Monioring And Observation
Reporting of All violations
Spill Managemnt
Traning
Superviosn
Safety Shower &Eye Wash
Monitoring and Appllication
Safety Check list
Training
Waste Managemnet
Traning
Monitoring
Observation
TB & airborne infections
Training
Monitoring
Emergency Information (Codes)
Training
Posting
Observation
Fire safety
Fire prevention rules Training
Fire Extinguishers (Type and uses ) Training
Emergency Exits Monitoring
Assimply point Monitoring training
Evacution Plan
Duty and responsibility in the evacation plan
Preparation and traning
Needle stick Injury and sharp injury (accidents )
Steps & Proceduer explaining
reporting training
Latex allergy
knowleage and preventions (Training)
Check list
Chemical safety
General knowlage of Hazmat
Monitoring of chemical safety cabenits
Expalin of chemical spill kit and how to use?
SDS list preparation and check up

Potentially carcenogenic chemicals explain and training

PEL & STEL training

Chemical waste (special waste) explain and traning
UV and Radiation Safety
Explain UV glass protection when and how to use ?
Radiation precautions if aplicable training
Disposal traning
Ergonomics Safety
Explain the concept
Application & Monitoring
Vaccination
All nessessary vaccins (check List )
Physical Environment
Explain physical hazards present in the laboratory
Personal Protective Equipment (PPE)
Monitor availability of PPE for general laboratory entery

Demonstrate use of specific PPE required for each laboratory

procedure
Implement correct use of PPE
Reporting use of PPE

Implement and reporting use of different types of masks

Engineering Control
Monitor availabilityof laboratory equipment with engineering
controls use to contain hazardous materials

Implement procedure required to report improperly functioning

engineering controls to senior level

Demonstrate knowledge of the laboratory facility engineering

control designed to prevent exposure or releseof hazardous
materials

Describe laboratory facility's controlled access system

Adhere to facility security rules

Describe facility design differences between BSL-2 and BSL-3
laboratories
Monitor adherence to procedures for cleaning of laboratory
containment areas
Hazard Communication and Signage
Implement safety signs, labels, and posted information

Explain signals and alarms

Write and implement laboratory manuals and plans
Safety Program Management
Implement institution's safety and occupational health programs

Monitor site-specific safety training program

Risk Management
Explain the difference in work practices between biosafety levels
in regards to potential hazard

Assess the ability to identify potentialhazard associated with

laboratory materials and procedure (risk assessment)

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.

Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.

Assessor's Signature: Date:

Recommendations
Action
Re-training & re-assessment (use the reassessment Items Date & Signature
form)
Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-16 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Reassessment Tool

Elements
Employee Name: Direct Observation DO
Monitoring Test Results MTR
Reason for reassessment: Record Review RR
Proficiency Testing PT
Evaluator(s): Performance of Maintenance PM
Problem Solving PS

Date Procedure Method of Passed Date resumed

Procedures Reassessed Retraining Date performing task
reviewed Reassessment Reassessment

Comments:

Additional training or reassessments if necessary:

Resons:

Employee Signature: Date

Trainer's Signature: Date
Reviwed & Approved by:

Lab Medical Director or Designee

LB-FO-P&P19-17 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024
 Kingdom of Saudi Arabia
Ministry of health
Directorate of health affairs – Taif
King Faisal Medical Complex
Laboratory & Blood Bank Department

Competency Assessment - Intrauterine Insemenation Type: O Initial/ O Semi-Annual/ O Annual

Elements
Employee Name:
1. Direct observations of routine patient test performance, including, as applicable, patient identification and preparation; and specimen collection, handling, processing and testing.

Position: 2. Monitoring the recording and reporting of test results, including, as applicable, reporting critical results
3. Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records
Date of Hire: 4. Direct observation of performance of instrument maintenance and function checks
5. Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples
Period of Evaluation: 6. Evaluation of problem-solving skills

Evaluator(s):

TEST SYSTEM 1 2 3 4 5 6 S/N Comments

Specimen Receiving
Explain instructions how collect the sample to patient
Specimens Acceptence & rejection critiria
Order the sample & receiving on LIS
Specimen processing
Washing steps & Activation
Staining
Microscopic sxamination (pre- & post-preparation)
Result
Recording the result
Quality Assurance procedure
Quality Control
External Quality Control (Professioncy Test)
Machine/Equipments maintenance
Document archiving & retaintion

S - Satisfactory
N - Needs additional training

I have read and understand the standard operating procedures for the tests listed above, and my questions and/or concerns have been sufficiently addressed.
Employee Signature: Date:

Based upon successful completion of this competency assessment, the employee is deemed to be competent to perform patient testing unsupervised.
Assessor's Signature: Date:

Recommendations
Action Items Date & Signature

Re-training & re-assessment (use the reassessment form)

Reviwed & Approved by:

Lab Medical Director or Designee

Code: LB-FO-P&P19-18 Issue No: 4 Issue Date: 1/07/2022 Activation Date:: 15/12/2022 Revision Date:: 01/12/2024