Scope of Practice and Competence Sign-Off Record
What this person may do here, and the evidence that they can: observed, signed, dated — and reviewed every year
What it is
A per-person scope-of-practice and competence record: the procedures and tasks the role includes, the level for each (may perform independently / under supervision / not yet), the evidence (observed by whom, when; training; log of cases), the annual review, and the request-and-approval line for extending scope.
Where to use it
Every clinical staff member; kept by the department lead; reviewed at annual appraisal; produced for surveyors. Evidence for: Governance — competence; Standard 4 — care by competent staff. Evidence for: Governance — competence; Standard 4 — care by competent staff.
Translate and adapt
English master edition. Georgian and other translations are added as they are clinically reviewed. Any facility may translate, add its logo and adapt wording to local practice — keeping the ASF block, the source attribution and the licence line on the sheet. Clinical thresholds and drug doses must be confirmed against national protocols before use.
The same code is printed on the tool itself. Scan it in any facility to reach this page.
Credential Verification Checklist — Before the First Shift
New Staff Induction Checklist — First Day, First Week, First Month
Mandatory Training Matrix — Who Needs What, How Often
Print to share.
