Annual Training Program Documentation

1 Created by: Mirabelle Management, LLC (952) 288 - 3800 minnesota Comprehensive home care Licensure Annual Training Documentation Employee Name: _____ Hire/Anniversary Date: _____ Total Required Annually: 8 hours Housing with Services Providers or Arranged home care in HWS Settings 2 hours every 12 months thereafter in topics related to dementia are required Housing with Services Providers Emergency Preparedness Training annually Training Area/Topic Delivery Method Date Competency Completed & Time Allocation Initials 1 EduCare Module: Infection Control Techniques Test Passed Score or % _____ Time: _____ _____ (Initials) 2 EduCare Module: home care Bill of Rights _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 3 EduCare Module: Vulnerable Adult _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 4 Organization Policies & Procedures _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 5 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 6 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 7 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 8 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 9 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 10 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 11 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 12 _____ (date) Test Passed Score or % _____ Time.

2 _____ _____ (Initials) 13 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 14 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 15 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials) 16 _____ (date) Test Passed Score or % _____ Time: _____ _____ (Initials)