Affidavit Of Competency For Resident Traineeship Embalming printable pdf download

Affidavit Of Competency For Resident Traineeship Embalming

AFFIDAVIT OF COMPETENCY FOR RESIDENT TRAINEESHIP

EMBALMING

)

In the matter of:

)

AFFIDAVIT OF:

)

____________________________,

)

___________________________

)

(Print Trainee Name)

(Print Supervisor Name)

I, _______________________, being first duly sworn, hereby depose and say as follows:

(Print Supervisor Name)

1. I am an adult over eighteen years of age and do not suffer from any physical or mental

conditions affecting my competency.

2. I am ________ licensee # _____, and I am employed by __________________________.

(FSL/EM)

(Name of Funeral Est.)

3. I have personally observed the above-named trainee perform various embalming activities,

and am familiar with the above-named trainee’s skills and competencies in the practice of

embalming.

4. I have personally observed the above-named trainee competently embalm decedents.

5. I have personally observed the above-named trainee consistently and competently use

universal safety precautions to prevent infectious disease.

6. I have personally observed the above-named trainee competently complete the following

activities during his or her traineeship:

a. Setting features;

b. Mixing fluids;

c. Raising vessels and inserting tubes;

d. Injecting fluids;

e. Suturing incisions;

f. Cavity treatment;

g. Removal and disinfecting of body;

h. Positioning of body;

i. Restorative art treatment including hypodermic treatment;

j. Preparation of autopsied body including treatment of viscera;

k. Treatment of remains following organ and/or tissue donation;

l. Application of cosmetics;

m. Dressing and casketing;

n. Cleaning and disinfection of preparation room;

o. Handling and/or disposing of biomedical waste.

Affidavit Of Competency For Resident Traineeship Embalming