Healthcare Training Attestation

HEALTHCARE TRAINING ATTESTATION

Employee / Trainee Information

Training Details

In-person    Online / eLearning    Blended

Infection prevention & control
Hand hygiene / PPE
HIPAA / patient privacy
Medication safety / administration
Emergency response / code procedures
Patient rights & informed consent
Safe patient handling / ergonomics
CPR / AED / basic life support
Other (describe below)

Competency Assessment

Was a competency assessment administered? Yes No

Acknowledgment and Certification

I certify that I completed the training described above and that the information contained in this attestation is true and accurate to the best of my knowledge. I understand that this training is a condition of my duties and that failure to comply with applicable policies, standards of care, or regulatory requirements may result in corrective action up to and including termination.

I acknowledge that I am responsible for applying the practices taught in this training, including but not limited to infection control measures, patient privacy protections, medication safety protocols, and emergency procedures. I understand that periodic audits and competency reassessments may be conducted to verify continued compliance and competence.

I understand that the employer will retain this attestation as part of my personnel and training records. This attestation will remain on file for the period required by applicable law and organizational policy. If an explicit retention end date is required, indicate below.

I further acknowledge that health information encountered in the course of my duties remains confidential and subject to applicable privacy laws and organizational policies. I attest that I have received training on privacy and confidentiality requirements and understand my obligations regarding protected health information.

I acknowledge receipt of privacy training and understand my obligations to protect patient information.

Additional Notes

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