# Training Record Form

| Form ID | FRM-004 | Revision | 1.0 |
|---------|---------|----------|-----|

---

## Section 1: Employee Information

| Field | Entry |
|-------|-------|
| Employee Name | |
| Employee ID | |
| Position/Title | |
| Department | |
| Hire Date | |

## Section 2: Training Information

| Field | Entry |
|-------|-------|
| Training Topic/Course Title | |
| Training Date | |
| Training Duration (hours) | |
| Training Type | ☐ Classroom ☐ Online ☐ On-the-job ☐ Self-study ☐ Conference |
| Trainer/Instructor Name | |
| Training Provider | |

## Section 3: Training Category

- [ ] New Employee Onboarding
- [ ] QMS/Quality Policy
- [ ] Regulatory Compliance (HIPAA, IDEA, etc.)
- [ ] Assessment Tool Training
- [ ] Clinical Protocol
- [ ] Safety and Emergency Procedures
- [ ] Software/Systems Training
- [ ] Professional Development
- [ ] Continuing Education
- [ ] Annual Refresher
- [ ] Other: _______________

## Section 4: Assessment Tool Specific Training (if applicable)

### Assessment Tool
- [ ] ADOS-2 (specify modules): _______________
- [ ] ADI-R
- [ ] Bayley-4
- [ ] WISC-V
- [ ] Stanford-Binet 5
- [ ] Vineland-3
- [ ] ASQ-3
- [ ] M-CHAT-R/F
- [ ] WIAT-4
- [ ] Conners Rating Scales
- [ ] Other: _______________

### Training Level
- [ ] Initial training
- [ ] Research-reliable certification
- [ ] Refresher training
- [ ] Inter-rater reliability check

### Certification/Reliability Status
- [ ] Certified
- [ ] Reliability achieved (specify %): _______________
- [ ] Certification expiration date: _______________

## Section 5: Training Objectives

*(List key learning objectives or competencies covered)*

1.
2.
3.

## Section 6: Assessment of Learning

### Assessment Method
- [ ] Written test (score: _______%)
- [ ] Practical demonstration
- [ ] Case review
- [ ] Direct observation
- [ ] Simulation/role-play
- [ ] Attendance only
- [ ] Other: _______________

### Assessment Result
- [ ] Competent (passed)
- [ ] Not yet competent (requires retraining)

### Comments




## Section 7: Competency Documentation

### Initial Competency Verified
- [ ] Yes
- [ ] No
- [ ] N/A

### Competency Verification Method
- [ ] Observation by supervisor
- [ ] Case audit
- [ ] Fidelity checklist
- [ ] Inter-rater reliability
- [ ] Other: _______________

### Competency Verified By | |
### Verification Date | |

## Section 8: Training Effectiveness

*(To be completed 30-90 days post-training)*

### Effectiveness Evaluation
- [ ] Employee applying skills correctly
- [ ] Additional support needed
- [ ] Retraining required

### Evaluated By | |
### Evaluation Date | |
### Comments | |

## Section 9: Continuing Education (if applicable)

| CE Credits | |
|------------|---|
| Licensing Board | |
| License Number | |

## Section 10: Signatures

| Employee Signature | | Date | |
|-------------------|---|------|---|
| Trainer Signature | | Date | |
| Supervisor Signature | | Date | |

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## Training History Summary

*(Use this section to track ongoing training - attach additional pages as needed)*

| Date | Training Topic | Hours | Trainer | Assessment Result |
|------|---------------|-------|---------|-------------------|
| | | | | |
| | | | | |
| | | | | |
| | | | | |

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*Form FRM-004 Rev 1.0*