Kingdom of Saudi Arabia

Ministry Of Health
Jazan Health Directorate
Prince Mohammed Bin Nasser Hospital

Nursing Education & Staff Development

Nursing Competency Program

HAZARDOUS MATERIALS

Employee Name: __________________________ ID No. : ___________________________

Department/Unit: __________________________ Date of Joining: ___________________
Competency Start Date: _____________________

Competency Assessment Instructions – This Template must NOT be altered:

1. All ELEMENTS of the Competency (KSA) must be assessed by the patient bedside.
2. Simulation in the Clinical Area or Skills Lab can be used if available and should only be used in exceptional
situations i.e. Clinical Area VERY busy.
3. It is essential that the Reference, Websites and Training Requirements be completed in advance of the
Competency assessment and NOT on the same day.
4. The Assessor is obliged to initial each element assessed and not √ - this happens in the first column.
5. The Remarks column should only be used to comment when the employee is unable to complete the element
being assessed. The Assessor is required to write a comment e.g. Needs more preparation and will be assed
again on the date and time”.
Competency Statement :
Ability to SAFELY manage, store and dispose of HAZARDOUS material in their area of practice.
Indicate N/A for any competency elements not relevant to area of practice.

Preceptor/ CRN
Knowledge (initial each element) Title Date Remarks
Signature ID#
1 State the nurse’s role and
responsibilities regarding the
management, storage and labeling of
HAZARDOUS MATERIALS in
----------
their area of practice

2 Explain the rationale for the fact that

all healthcare providers and waste
handlers must have up-to-date
---------- hepatitis immunizations
3 Identify all HAZARDOUS medical
waste requiring special disposals in
---------- area of practice.
4 Explain rationale for obtaining
appropriate HAZARDOUS medical
waste disposal containers in area of
---------- practice
5 Discuss segregating HAZARDOUS
medical waste based on specific type
and appropriate disposal of same as
---------- relevant to area of practice

Approved for Use in 26-June-18 NS Page 1

 Kingdom of Saudi Arabia
Ministry Of Health
Jazan Health Directorate
Prince Mohammed Bin Nasser Hospital

Nursing Education & Staff Development

Nursing Competency Program

HAZARDOUS MATERIALS

6 Discuss the process for ordering,

---------- transporting, receiving and storage of
all HAZARDOUS MATERIALS
appropriate to area of practice
7 Refer to the appropriate Material
---------- Safety Data Sheet (MSDS) document
for proper disposal of each specific
type of HAZARDOUS waste as
relevant to area of practice

8 Describe the meaning of the different

---------- classification of risk and be able to
differentiate between the
HAZARDOUS levels using the
colors and numbers used to identify
chemicals/materials.

9 Explain the role and responsibilities

---------- of other personnel coming into area
of practice regarding HAZARDOUS
MATERIALS

Preceptor/ CRN
Skills (initial each element) Title Date Remarks
Signature ID#
1 Identify the HAZARDOUS
---------- MATERIALS in area of practice

2 Locate Chemical Hazard Bulletins

---------- (CHB) and/or the manufacturer’s
Material Safety Data Sheets (MSDS)
folder
3 Obtain and use personal protective
---------- equipment (PPE) before disposing of
HAZARDOUS medical waste
4 Put on PPE appropriate to anticipated
---------- exposure in area of practice
5 Dispose of infectious material waste
---------- based on specific type

6 Demonstrate how to properly manage

---------- a spill of a HAZARDOUS
MATERIAL in area of practice

Approved for Use in 26-June-18 NS Page 2

 Kingdom of Saudi Arabia
Ministry Of Health
Jazan Health Directorate
Prince Mohammed Bin Nasser Hospital

Nursing Education & Staff Development

Nursing Competency Program

HAZARDOUS MATERIALS
7 Completes documentation to record
---------- HAZARD identified and the correct
disposal of same
Preceptor/ CRN
Attitude (initial each element) Title Date Remarks
Signature ID#
1 Show a belief that the environment
---------- created in the area of practice and the
hospital as a whole, can affect the
SAFETY for healthcare providers,
patients and relatives and has a direct
impact on the quality of care given in
the area of practice.
2 Actively promote SAFETY in area of
---------- practice and with specific regard to
HAZARDOUS MATERIALS.
3 Self-aware to limitation in knowledge
---------- and skills.
4 Demonstrate ability to organize and
---------- facilitate a Reflection session in and
on practice after a HAZARDOUS
MATERIAL learning opportunity
occurs and activate findings to
improve future practice and response.
Reference, Websites and Training Requirements:
(These must be completed at least 1 month prior to the Competency Assessment. Policies must be
numbered with the Policy Title; Books referenced must state the specific Chapter for employee to read.)
Reference, Websites and Training Date Employee Signature

www.epa.gov/waste/hazard/
www.journals.elsevier.com/journal-of-hazardous-materials/
www.the-ncec.com/chemdata
www.hazmatuniversity.com/‎
phmsa.dot.gov/hazmat

Specific Learning Performance Learning Strategies Comments for Follow-up

Opportunity Expectations with Agreed with Deadline Learning Strategies and
Identified Deadline Deadline Date/s
1. 1. 
2.
3.
4.
5.

Approved for Use in 26-June-18 NS Page 3

 Kingdom of Saudi Arabia
Ministry Of Health
Jazan Health Directorate
Prince Mohammed Bin Nasser Hospital

Nursing Education & Staff Development

Nursing Competency Program

HAZARDOUS MATERIALS
Competency Completed by: ___________________________________
Designation: _______________________________________________
Date: _____________________

NAME OF EMPLOYEE ID # SIGNATURE DATE COMPETENCY

ASSESSMENT
COMPLETED

When completed, the Original must be given to the CRN who will collate the Compliance Rates for
the Unit and before sending it on to the Education Department. The Education Department will
collate the Compliance Rates for the Nursing Services Department. The Original is to be given to
the Employee for their Portfolio and a hard copy kept in the Employee’s Unit and Nursing
Department file.

Original – Employee for Portfolio

Copy held by Head Nurse/CRN in Unit
Copy held in Nursing/Education Department

Approved for Use in 26-June-18 NS Page 4