157 lines
3.2 KiB
Markdown
157 lines
3.2 KiB
Markdown
# Training Record Form
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| Form ID | FRM-004 | Revision | 1.0 |
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|---------|---------|----------|-----|
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---
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## Section 1: Employee Information
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| Field | Entry |
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|-------|-------|
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| Employee Name | |
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| Employee ID | |
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| Position/Title | |
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| Department | |
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| Hire Date | |
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## Section 2: Training Information
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| Field | Entry |
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|-------|-------|
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| Training Topic/Course Title | |
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| Training Date | |
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| Training Duration (hours) | |
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| Training Type | ☐ Classroom ☐ Online ☐ On-the-job ☐ Self-study ☐ Conference |
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| Trainer/Instructor Name | |
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| Training Provider | |
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## Section 3: Training Category
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- [ ] New Employee Onboarding
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- [ ] QMS/Quality Policy
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- [ ] Regulatory Compliance (HIPAA, IDEA, etc.)
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- [ ] Assessment Tool Training
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- [ ] Clinical Protocol
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- [ ] Safety and Emergency Procedures
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- [ ] Software/Systems Training
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- [ ] Professional Development
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- [ ] Continuing Education
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- [ ] Annual Refresher
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- [ ] Other: _______________
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## Section 4: Assessment Tool Specific Training (if applicable)
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### Assessment Tool
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- [ ] ADOS-2 (specify modules): _______________
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- [ ] ADI-R
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- [ ] Bayley-4
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- [ ] WISC-V
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- [ ] Stanford-Binet 5
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- [ ] Vineland-3
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- [ ] ASQ-3
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- [ ] M-CHAT-R/F
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- [ ] WIAT-4
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- [ ] Conners Rating Scales
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- [ ] Other: _______________
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### Training Level
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- [ ] Initial training
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- [ ] Research-reliable certification
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- [ ] Refresher training
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- [ ] Inter-rater reliability check
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### Certification/Reliability Status
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- [ ] Certified
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- [ ] Reliability achieved (specify %): _______________
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- [ ] Certification expiration date: _______________
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## Section 5: Training Objectives
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*(List key learning objectives or competencies covered)*
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1.
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2.
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3.
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## Section 6: Assessment of Learning
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### Assessment Method
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- [ ] Written test (score: _______%)
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- [ ] Practical demonstration
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- [ ] Case review
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- [ ] Direct observation
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- [ ] Simulation/role-play
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- [ ] Attendance only
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- [ ] Other: _______________
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### Assessment Result
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- [ ] Competent (passed)
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- [ ] Not yet competent (requires retraining)
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### Comments
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## Section 7: Competency Documentation
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### Initial Competency Verified
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- [ ] Yes
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- [ ] No
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- [ ] N/A
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### Competency Verification Method
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- [ ] Observation by supervisor
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- [ ] Case audit
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- [ ] Fidelity checklist
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- [ ] Inter-rater reliability
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- [ ] Other: _______________
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### Competency Verified By | |
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### Verification Date | |
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## Section 8: Training Effectiveness
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*(To be completed 30-90 days post-training)*
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### Effectiveness Evaluation
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- [ ] Employee applying skills correctly
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- [ ] Additional support needed
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- [ ] Retraining required
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### Evaluated By | |
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### Evaluation Date | |
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### Comments | |
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## Section 9: Continuing Education (if applicable)
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| CE Credits | |
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| Licensing Board | |
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| License Number | |
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## Section 10: Signatures
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| Employee Signature | | Date | |
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| Trainer Signature | | Date | |
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| Supervisor Signature | | Date | |
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---
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## Training History Summary
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*(Use this section to track ongoing training - attach additional pages as needed)*
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| Date | Training Topic | Hours | Trainer | Assessment Result |
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|------|---------------|-------|---------|-------------------|
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---
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*Form FRM-004 Rev 1.0*
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