Blood Glucose/Sugar Check Off
Completed by a Noble Nurse while evaluating an Employee's Competency. The Nurse and the Employee must sign the completed checklist at the time of evaluation.
Employee Name:
First Name
Last Name
Employee Title:
Please Select
Direct Support Professional
Team Lead
Site Lead
Administrative Assistant- East
Administrative Assistant-BE
Art Specialist
Asst. Vice President of Programs
Camp Lead
Career Discovery Experience Facilitator
Director
Director, Community Integration
Director
Planning & Program Manager, Respite
Program Manager
Quality Support Coordinator, Community Living
Other
Title:
Trainer:
Please Select
Karen Gray, Nurse
Joanne Hester, Nurse
Lucy Byrnes, Nurse
Marlin King, Nurse
Annabelle Hardwick, Nurse
Chad Linn, VP of Compliance & Operations, Nurse
Other
Time
Hour Minutes
AM
PM
AM/PM Option
Date:
-
Month
-
Day
Year
Date
Duration:
Please Select
0.25
0.50
0.75
1.0
1.25
1.50
Location of Training:
Please Select
Noble East
Noble West
Noblesville
Other
Location:
Name of Client:
First Name
Last Name
Voices understanding:
Pass
Fail
NA
Makes sure hands are clean and dry
Demonstrates proper use of gloves when assisting
Demonstrates proper use of glucometer operation and lancet
Cleans finger with alcohol pad and lets it dry completely
Holds the individuals hands down to let blood flow into fingers
If blood flow is minimal the staff understands that they can try rubbing, massaging, or gently milking fingers prior to the stick for better results
Sticks finger towards the sides, not the middle of the pads
Wipes off the 1st drop of blood
Saturates the test strip with blood
Applies pressure to the stick area until bleeding stops
Correctly reads the meter
Based on the meter reading, takes appropriate action
Documents the reading correctly
Based on this Competency Tool, it is determined that the employee is competent to complete Blood Sugar checks.
Yes
No
Employee Signature:
Nurse Signature:
Save
Submit
Submit
Blood Sugar/ Glucose Skills Check Off Created: 4/3/25
Should be Empty: