developmental-pediatrics/Forms/FRM-004-Training-Record.md

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)

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

---

Training History Summary

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

Date	Training Topic	Hours	Trainer	Assessment Result

---

Form FRM-004 Rev 1.0