Pennsylvania Training Acknowledgment

PA TrainingMonea Jones2023-10-20T16:59:40-04:00

Annual Training Acknowledgment Form

Annual Training Attendee

Annual Training Attendee

First Name

First Name

Last Name

Last Name

Personal Care Orientation Training:

• Abuse and Neglect Training 
• Fraud and Abuse Training 
• Incident Report Training 
• QAPI Training 
• Complaint Management Training

Acknowledgement:

By signing this form, I am verifying that I have received annual training on the following topics above. I understand how the subjects covered applies to how I fulfill my role as a Direct Care Worker. I agree to consistently apply the trainings received and to demonstrate safe work practices while performing my duties. I have been given a chance to have my questions answered, and they were answered to my satisfaction. I am aware if I have further questions after orientation, I can contact my supervisor or client relationship manager for more clarification.

Signature

Date

Authorized Annual Training Administrator:

If you are human, leave this field blank.

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