NUCLEAR MEDICINE TECHNOLOGY PROGRAM COMPETENCY EVALUATION - RADIOPHARMACY Student: ____________________________________ Date: ____________________________ Hospital: ___________________________________

1 = satisfactory, 0 = unsatisfactory, NATO = not able to observe, NA = Not applicable

_____ 1. _____ 2. _____ 3. _____ 4. _____ 5. _____ 6. _____ 7. _____ 8. _____ 9. _____ 10. _____ 11. _____ 12. _____ 13. _____ 14. _____ 15. Comments:

Wears film and ring badge daily Wears disposable gloves and lab coat when working in hot lab Performs wipe test and surveys packages Elutes generator performs 99Mo assay Uses pre-established technique in preparing radiopharmaceutical kits Uses aseptic technique. Performs quality control procedures on dose calibrator. Performs quality control procedures on radiopharmaceutical kits Demonstrates proper record keeping and labels vials. Checks expiration dates on radiopharmaceutical kits Calculates and draws up doses Properly disposes of radioactive materials Demonstrates ability to handle contamination Practices good housekeeping in hot lab

Passed: _____ Comments:

Failed: _____

Evaluator: __________________________________

Date: ____________

NMT-264clinical competency-radiopharmacy.wpd