Delegation Updates The signatures below certify the care giver(s) were trained in performing the delegated task listed below in accordance with the Oregon Scope of Practice Rules; were competent and agreed to perform the task; and understand the task is not transferable to another client or care giver. Client/Resident name Task Training Methods/ return demonstration date Training Outcomes/Comments
RN Signature
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Care Giver Signature
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Training Methods/ return demonstration date Training Outcomes/Comments
RN Signature
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Care Giver Signature
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Training Methods/ return demonstration date Training Outcomes/Comments
RN Signature
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Care Giver Signature
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Training Methods/ return demonstration date Training Outcomes/Comments
RN Signature
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Care Giver Signature
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Training Methods/ return demonstration date Training Outcomes/Comments
RN Signature
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Care Giver Signature
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Training Methods/ return demonstration date Training Outcomes/Comments
RN Signature
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Care Giver Signature
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Training Methods/ return demonstration date Training Outcomes/Comments
RN Signature
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Care Giver Signature
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Training Methods/ return demonstration date Training Outcomes/Comments
RN Signature
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Care Giver Signature
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Training Methods/ return demonstration date Training Outcomes/Comments
RN Signature
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Care Giver Signature
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Last Update: January 2014
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