MLT Practicum
Chemistry Performance Checklist
Name: ______ Site:
Part I Functional Area/Competency CriteriaCritical Control Points (CCP) / Competency and Performance Evaluation / Site
Instructor
Initials / Date
Evaluation Code
(Check all that apply) / Rating Score
(Circle one)
Student must be proficient in (able to perform independently)
the following procedures:
Use “N/A” if procedure not performed at site. / Observation / Concept Discussed / Student Performed / 1 = Below average
2 = Average
3 = Above average
4 = Exceeds
A. General Laboratory Procedures
1. Specimen processing, to include suitability of specimen for testing / 1 2 3 4
2. Specimen requirements / 1 2 3 4
3. Daily temperature records / 1 2 3 4
4. Preparation of calibrators and controls (pipettes used, proper procedure, expiration dates) / 1 2 3 4
5. Reporting results / abnormal values / critical values / 1 2 3 4
6. Assay linearities / dilutions and diluents / 1 2 3 4
7. Processing low-volume samples / 1 2 3 4
B. Automated Instrumentation
1. Beckman DxC800
a. General:
i. Analytical Components/Modular and Cartridge Compartments / 1 2 3 4
ii. Principles of Operation/Modular Chemistries / 1 2 3 4
iii. Principles of Operation/Cartridge Chemistries / 1 2 3 4
iv. Reagent preparation and Loading / 1 2 3 4
v. Reagent Inventory and Consumables Management / 1 2 3 4
vi. Specimen Loading/Rack Selection / 1 2 3 4
vii. Manual Programing of Specimens / 1 2 3 4
viii. Datalink/Programing of dilutions and reruns / 1 2 3 4
ix. Quality Control/Corrective Action for out-of-range QC / 1 2 3 4
x. Levy-Jennings chart review / 1 2 3 4
xi. Calibration / 1 2 3 4
Functional Area/Competency Criteria
Critical Control Points (CCP) / Competency and Performance Evaluation / Site
Instructor
Initials / Date
Evaluation Code
(Check all that apply) / Rating Score
(Circle one)
Student must be proficient in (able to perform independently)
the following procedures:
Use “N/A” if procedure not performed at site. / Observation / Concept Discussed / Student Performed / 1 = Below average
2 = Average
3 = Above average
4 = Exceeds
xii. Daily Preventive Maintenance / 1 2 3 4
xiii. Weekly Maintenance / 1 2 3 4
b. Tests performed:
i. Ion Selective Electrode Chemistries:
Sodium, Potassium, Chloride, CO2, Calcium / 1 2 3 4
ii. Modular Chemistries:
Albumin, BUN, Creatinine, Glucose, Phosphorus, Total Protein / 1 2 3 4
iii. Cartridge Chemistries:
- General Chemistries: Magnesium, Total/Direct Bili, Uric Acid,
b. Enzymes: Amylase, AST, ALT, ALK PHOS, LIP, CK, LD, GGT / 1 2 3 4
c. Cardiac Risk Factors: Chol, Trig, HDL, Calculations, CRP,
Homocysteine / 1 2 3 4
- Anemia Markers: Iron, Transferrin, TIBC & % Saturation
- Therapeutic Drugs: Carbamazepine, Digoxin, Gentamicin,
Valproic Acid / 1 2 3 4
- Drugs of Abuse: Acetaminophen, Salicylate, Alcohol,
Cannabinoids, Methadone, Opiates / 1 2 3 4
- Fluid Chemistries: Urine: Sodium, Potassium, Chloride, Urea
Protein, Uric Acid; All 24 hour urine calculations; CSF: Glucose, Total Protein, LDH / 1 2 3 4
g. User Defined Chemistries: Homocysteine, Renal Albumin / 1 2 3 4
Functional Area/Competency Criteria
Critical Control Points (CCP) / Competency and Performance Evaluation / Site
Instructor
Initials / Date
Evaluation Code
(Check all that apply) / Rating Score
(Circle one)
Student must be proficient in (able to perform independently)
the following procedures:
Use “N/A” if procedure not performed at site. / Observation / Concept Discussed / Student Performed / 1 = Below average
2 = Average
3 = Above average
4 = Exceeds
- Beckman DxI 800
i. Analytical Components and Software Navigation / 1 2 3 4
ii. Principles of Operation/Assay Technology / 1 2 3 4
iii. Reagent Inventory and Consumables Management / 1 2 3 4
iv. Specimen Loading/Rack selection / 1 2 3 4
v. Quality Control/Corrective Action for out-of-range QC / 1 2 3 4
vi. Levy-Jennings chart review / 1 2 3 4
vii. Calibration / 1 2 3 4
viii. Daily Preventative Maintenance/Test Count & Clean Routines / 1 2 3 4
ix. Review 5000/10,000 Test Maintenance / 1 2 3 4
x. Datalink /Programing of dilutions / 1 2 3 4
xi. Basic troubleshooting / 1 2 3 4
b. Tests performed: / 1 2 3 4
i. Cardiac Markers: BNPT, CKMB, TROP (TNI), MYO / 1 2 3 4
ii. Thyroid Hormones: TSH, T4, FT4,TT3, TU / 1 2 3 4
iii. Anemia Markers: VITB12, FOL, FERR / 1 2 3 4
iv. Tumor Markers: CEA, PSA, fPSA / 1 2 3 4
v. Miscellaneous: HCGB, COR, PTH / 1 2 3 4
Functional Area/Competency Criteria
Critical Control Points (CCP) / Competency and Performance Evaluation / Site
Instructor
Initials / Date
Evaluation Code
(Check all that apply) / Rating Score
(Circle one)
Student must be proficient in (able to perform independently)
the following procedures:
Use “N/A” if procedure not performed at site. / Observation / Concept Discussed / Student Performed / 1 = Below average
2 = Average
3 = Above average
4 = Exceeds
3. Beckman Access2 Immunoassay System
a. General:
i. Analytical Components and Software Navigation / 1 2 3 4
ii. Principles of Operation/Assay Technology / 1 2 3 4
iii. Reagent Inventory and Consumables Management / 1 2 3 4
iv. Quality Control/Corrective Action for out-of-range QC / 1 2 3 4
v. Levy-Jennings chart review / 1 2 3 4
vi. Calibration / 1 2 3 4
vii. Daily Preventative Maintenance / 1 2 3 4
viii. Weekly Preventative Maintenance / 1 2 3 4
ix. Basic troubleshooting / 1 2 3 4
b. Tests Performed:
i. Cardiac Markers: BNPT, CKMB, TROP (TNI), MYO / 1 2 3 4
ii. Reproductive Hormones: FSH, LH, PROL, TESTO / 1 2 3 4
iii. Immunoglobulins: IGE / 1 2 3 4
4. Abbott Architect i1000
a. Analytical Components and Software Navigation / 1 2 3 4
b. Principles of Operation/Assay Technology / 1 2 3 4
c Reagent Inventory and Consumables Management / 1 2 3 4
Functional Area/Competency Criteria
Critical Control Points (CCP) / Competency and Performance Evaluation / Site
Instructor
Initials / Date
Evaluation Code
(Check all that apply) / Rating Score
(Circle one)
Student must be proficient in (able to perform independently)
the following procedures:
Use “N/A” if procedure not performed at site. / Observation / Concept Discussed / Student Performed / 1 = Below average
2 = Average
3 = Above average
4 = Exceeds
d. Quality Control/Corrective Action for out-of-range QC / 1 2 3 4
e. Levy-Jennings chart review / 1 2 3 4
f. Calibration / 1 2 3 4
g. Daily Preventative Maintenance / 1 2 3 4
h. Weekly Preventative Maintenance / 1 2 3 4
i. Basic troubleshooting / 1 2 3 4
j. Demonstrate ability to pretreat and run TACRO/CYCLO / 1 2 3 4
5. Abbott TDX/FLX
a. Analytical Components / 1 2 3 4
b. Keypad Navigation / 1 2 3 4
c. Theory of Operation / 1 2 3 4
d. Daily Maintenance / 1 2 3 4
e. Weekly Maintenance / 1 2 3 4
f. Quality Control/Corrective Action for out-of-range QC / 1 2 3 4
g. Levy-Jennings chart review / 1 2 3 4
h. Calibration / 1 2 3 4
i. Basic Troubleshooting / 1 2 3 4
j. Perform Methotrexate and Amikacin assays / 1 2 3 4
k. Perform Onboard Dilution Procedure / 1 2 3 4
Functional Area/Competency Criteria
Critical Control Points (CCP) / Competency and Performance Evaluation / Site
Instructor
Initials / Date
Evaluation Code
(Check all that apply) / Rating Score
(Circle one)
At a minimum, student must perform on practice specimens, observe and/or discuss the following procedures:
Use “N/A” if procedure not performed at site. / Observation / Concept Discussed / Student Performed / 1 = Below average
2 = Average
3 = Above average
4 = Exceeds
6. Advanced Instrument Micro-Osmometer
a. Instrument Components / 1 2 3 4
b. Theory of Operation / 1 2 3 4
c. Calibration Procedure / 1 2 3 4
d. Perform Serum and Urine Assays / 1 2 3 4
7. Bayer 348 Ionized Ca/Ph Analyzer
a. Instrument Components / 1 2 3 4
b. Keypad Navigation / 1 2 3 4
c. Theory of Operation / 1 2 3 4
d. Reagent Inventory Management / 1 2 3 4
e. Perform Daily Maintenance / 1 2 3 4
f. Weekly Maintenance/Deproteinizing & Conditioning / 1 2 3 4
g. Quality Control/Corrective Action for out-of-range QC / 1 2 3 4
h. Describe Specimen Requirements / 1 2 3 4
i. Perform CAI and pH Assays / 1 2 3 4
j. Perform Basic Troubleshooting / 1 2 3 4
8. Stanbio Ketosite
a. Demonstrate Navigation of Instrument Menu / 1 2 3 4
b. List Necessary Reagents/Storage Requirements / 1 2 3 4
Functional Area/Competency Criteria
Critical Control Points (CCP) / Competency and Performance Evaluation / Site
Instructor
Initials / Date
Evaluation Code
(Check all that apply) / Rating Score
(Circle one)
At a minimum, student must perform on practice specimens, observe and/or discuss the following procedures:
Use “N/A” if procedure not performed at site. / Observation / Concept Discussed / Student Performed / 1 = Below average
2 = Average
3 = Above average
4 = Exceeds
c. Explain Theory of Operation / 1 2 3 4
d. Perform Start-up Procedure and Daily QC / 1 2 3 4
e. Perform Ketone Assay and Dilution Protocol for out of range samples / 1 2 3 4
f. Explain Conversion Factor / 1 2 3 4
9. Adeza TLiq Analyzer/Fetal Fibronectin
a. Demonstrate Navigation of Instrument Menu / 1 2 3 4
b. List Necessary Reagents/Storage Requirements / 1 2 3 4
c. Theory of Operation / 1 2 3 4
d. Demonstrate Start-up Procedure / 1 2 3 4
e. Calibration Procedure / 1 2 3 4
f. Describe Specimen Requirements / 1 2 3 4
g. Perform FEFI Assay/Interpret Results / 1 2 3 4
10. Biomerieux Mini Vidas
a. Analytical Components and Software Navigation / 1 2 3 4
b. Reagent Inventory and Consumables Management / 1 2 3 4
c. Principles of Operation /Assay Technology / 1 2 3 4
d. Perform Daily Maintenance / 1 2 3 4
e. Weekly Preventative Maintenance / 1 2 3 4
Functional Area/Competency Criteria
Critical Control Points (CCP) / Competency and Performance Evaluation / Site
Instructor
Initials / Date
Evaluation Code
(Check all that apply) / Rating Score
(Circle one)
At a minimum, student must perform on practice specimens, observe and/or discuss the following procedures:
Use “N/A” if procedure not performed at site. / Observation / Concept Discussed / Student Performed / 1 = Below average
2 = Average
3 = Above average
4 = Exceeds
f. Assay Calibration / 1 2 3 4
g. Quality Control/Corrective Action for out-of-range QC / 1 2 3 4
h. Perform Procalcitonin Assay/Interpret Results / 1 2 3 4
11. Digital Chloridometer
a. List Reagents and Equipment Necessary / 1 2 3 4
b. Discuss Instrument Operating Principles / 1 2 3 4
c. Perform Daily Maintenance / 1 2 3 4
d. Perform Proper Blank Adjustment / 1 2 3 4
e. Quality Control/Corrective Action for out-of-range QC / 1 2 3 4
f. Describe Specimen Requirements / 1 2 3 4
g. Demonstrate Ability to Perform Sweat Chloride Assay / 1 2 3 4
12. Miscellaneous Procedures
a. Demonstrate Competency in Use of Analytical Balance / 1 2 3 4
b. Demonstrate Competency in Performing Manual Dilutions / 1 2 3 4
c. Use of Specimen Storage/Retrieval System / 1 2 3 4
d. Lipemic Specimen Clarification/Ultracentrifuge / 1 2 3 4
e. Fluid pH determinations using litmus paper / 1 2 3 4
Functional Area/Competency Criteria
Critical Control Points (CCP) / Competency and Performance Evaluation / Site
Instructor
Initials / Date
Evaluation Code
(Check all that apply) / Rating Score
(Circle one)
At a minimum, student must perform on practice specimens, observe and/or discuss the following procedures:
Use “N/A” if procedure not performed at site. / Observation / Concept Discussed / Student Performed / 1 = Below average
2 = Average
3 = Above average
4 = Exceeds
f. Demonstrate Awareness of Proficiency Testing / 1 2 3 4
TOTAL PART I CHECKLIST SCORE
Part II Functional Area/Competency Criteria
Critical Control Points (CCP) / Performance Evaluation / Site
Instructor
Initials / Date
Rating Score (circle one)
1. Punctuality and attendance – Is never late or absent unless absolutely necessary; arranges
for and completes makeup time in a timely fashion; never abuses break time. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
2. Accuracy – Obtains reliable results; recognizes results as normal / abnormal / questionable;
recognizes instrument, clerical and technical errors and takes corrective action. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
3. Initiative – Is willing and able to assume responsibility; seeks opportunities to learn; utilizes
time to its maximum; can be depended on to follow through. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
4. Productivity – Completes assignments within an acceptable amount of time; performs tasks
under pressure without loss of accuracy. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
5. Ability to learn – Performs tasks after minimal instruction; transfers information from lecture
to bench work. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
6. Thoroughness – Performs tasks to completion; transcribes or enters results accurately and
legibly; demonstrates ability to maintain equipment; follows safety procedures. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
7. Cooperation and ability to accept criticism – Cooperates with others; accepts and conforms
to rules; accepts constructive criticism and tries to correct deficiencies. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
8. Communication – Gives verbal and written information clearly, accurately and courteously. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
9. Organization – Plans and completes work in a manner that efficiently utilizes available
resources and time. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
10. Observes hospital policies, dress code, and HIPAA standards. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
11. Safety – Observes laboratory safety procedures to include proper use of personal protective
equipment. / 1 – Below Average 2 – Average
3 – Above Average 4 – Exceeds
TOTAL PART II CHECKLIST SCORE
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