Supervised ECG acquisition observation
Use this sheet during one directly observed 12-lead acquisition. Mark each action I (independent), P (performed with prompting), or N (not observed). Record specific feedback and repeat the observation when needed. Follow your institution's policy and scope.
Privacy: Do not write a patient name, date of birth, record number, image, or other patient identifier on this sheet.
| Observable action | I P N | Feedback / evidence |
|---|---|---|
| Before acquisition | ||
| Verifies the order and two patient identifiers using the approved workflow. | □ □ □ | |
| Explains the procedure, addresses questions and consent requirements, and protects privacy. | □ □ □ | |
| Uses indicated precautions; checks machine, supplies, electrode integrity, and cleanliness. | □ □ □ | |
| Acquisition and quality | ||
| Positions the patient safely and comfortably; prepares skin and manages cables. | □ □ □ | |
| Uses anatomic landmarks to place the ten electrodes and checks cable connections. | □ □ □ | |
| Verifies speed, gain, calibration, lead selection, and recording of all twelve views. | □ □ □ | |
| Identifies signal limitations, corrects their source when possible, and repeats when indicated. | □ □ □ | |
| Patient response and record | ||
| Observes patient state and responds to concerning symptoms or findings under local protocol. | □ □ □ | |
| Checks the correct chart destination and preserves acquisition details and repeat limitations. | □ □ □ | |
| Gives a concise handoff with patient context, observed tracing, limitations, action, and time. | □ □ □ | |
Supervised live ECG practice log
Use this page for a patient-identifier-free summary of supervised acquisitions. The supervisor or program keeps any supporting evidence through its approved process. A numbered row is a learning record; the institution determines eligibility and competency.
| # | Date | Skill / setting notes (no patient details) | Supervisor initials |
|---|---|---|---|
| 1 | |||
| 2 | |||
| 3 | |||
| 4 | |||
| 5 | |||
| 6 | |||
| 7 | |||
| 8 | |||
| 9 | |||
| 10 |
Supervisor synthesis
Skills consistently independent
Skills needing more supervised practice
This teaching record does not certify completion of an external credential's eligibility requirements. Confirm current requirements and acceptable documentation with the credentialing body and program.