In-service, Training, and Staffing

Meeting Summary and Attendance Form

January 11, 2017   /

Date:
________________________
Time:
________________________
Program title:
______________________________________________________________
Presenter(s):
_______________________________________________________________

  • In-service
  • Regularly scheduled meeting
  • Mandatory education
  • Competency
  • Continuing education (CE/CEU)
  • Student orientation
  • Other: __________________

Program needs
Program needs based on:

  • New product, service, vendor agreement, or review
  • Clinical development
  • Nonclinical employee development
  • Identified performance improvement or quality assurance issue that need addressed
  • Corporate requirement
  • Annual meeting/review
  • Interdepartmental continuity of care
  • Survey/inspection preparedness

Objectives
At the end of this session, attendees will know how to:

1.___________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

2.____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

3.____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

 
Method of instruction/discussion

  • Lecture
  • Slides
  • Video
  • Audiotape
  • Group discussion or study group
  • Question and answer
  • Self-directed learning
  • Printed handout
  • Article/study review
  • Case presentation
  • Exhibit or workshop
  • Web based
  • Other: __________________

Form of evaluation

  • Written test
  • Demonstration
  • Participant presentation
  • Open-ended questions or problems
  • Demonstration of change in work area
  • Other: __________________

Measured outcomes
Result of measured outcomes (based on objectives listed above): 
__________________________________________________________
__________________________________________________________
__________________________________________________________

Attendance Record

Signature

Printed Name

Position/Department

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach a copy of all handouts used, formal meeting minutes, and the lesson plan. Forward one completed copy to the director of education, and keep another copy in department files.