Agency Name: ____________________________________ Date: ______________ Reviewer: _________________________________ to no of to no & 3 later began to hire) months months (prior (no or later later later (prior Training months 6 year) 6 began no no no (after (must functioning competency) 1 Checklist 9 after & & & hire) hire (prior Checklist or Drill responsibility) of Functioning Modules Modules than functioning Training hire) hire) hire) hire than after after (within Employment Training months (within Training independent later Disaster 6 after after after after later Needs to no functioning functioning functioning months Training Competency months independent no & Competency supervisory Training Administration Training and hire) to I I 6 II II 6 than Training services) services) of Independent (prior Supported independent and documentation months months months months Position of Management Date Prevention to hire) Aid 6 6 6 6 later than than Phase Phase Phase Phase (prior date STEP assuming no Medication Name and Waiver(s) months Hire Date & Title/ CPR Crisis CDS CDS CDS providing CDS providing Case of KY First after Emergency Supervisory Specialist functioning than than than (prior than the Individualized independent independent independent later later include
Agency Name: ____________________________________ Date: ______________ Reviewer: _________________________________ Name and Waiver(s) Title/ Position Hire Date Date of Independent Functioning CPR (prior to independent functioning & no later than 6 months after hire) First Aid (prior to independent functioning & no later than 6 months after hire) Crisis Prevention Training (prior to independent functioning & no later than 6 months after hire) Individualized Needs Training (prior to independent functioning & no later than 6 months after hire) CDS Phase I Training Modules (prior to independent functioning & no later than 6 months after hire) CDS Phase I Competency Checklist (prior to independent functioning & no later than 6 months after hire) CDS Phase II Training Modules (no later than 6 months after hire or began providing services) CDS Phase II Competency Checklist no later than 6 months after hire or began providing services) Medication Administration (must include documentation of competency) Emergency and Disaster Drill Training Case Management Training (after 3 months and no later than 9 months of the date of hire) Supervisory Training (within 6 months of assuming supervisory responsibility) KY STEP Supported Employment Specialist Training (within 1 year)
Checklist-PersonnelNHE.docx