Form 5497-NATCEP, Texas Nurse Aide Performance Record

Instructions

Updated: 4/2024

Purpose

The Texas Nurse Aide Performance Record is a list of 45 Procedural Guidelines. They must be taught in approved NATCEPs. 

Procedure

The instructor must start a Nurse Aide Performance Record for each trainee at the start of a NATCEP as follows:

• Copy blank forms as needed. 
• Complete the identifying information at the top of the form. 
• Explain the use of the Performance Record to trainees.

During the training program the instructor must: 

• Procedural Guidelines - Teach all the listed throughout the form.
  • Evaluate the competency of each trainee in the classroom, skills lab or  clinical training by checking the appropriate box on the form. 
  • Check off each procedural guideline listed in Sections I-XI for all trainees.
• Performance Record - Enter S for Satisfactory or U for Unsatisfactory, the date and the initials corresponding to the signature in the appropriate column of the performance record. 
  • The procedural guidelines that are not prometric skills must be taught and checked off at least in the classroom, in the skills lab or in clinical.
  • Use the procedural guidelines as the criteria to determine S or U performance.    
  • The procedural guidelines that are Prometric Skills must be taught and checked off in the Skills Lab, Clinical to assure trainees are competent to perform the skills and pass the test. Use the Prometric skills as the criteria to determine S or U performance. 
• Completion of Training Program
  • Check off as S for each nurse aide all the Procedural Guidelines listed on the Performance Record.     
  • Give the nurse aid a copy of their completed Performance Guideline.
  • Give the employer a copy of the trainee’s completed Performance Guideline, if applicable.
  • The NATCEP must retain a copy of Performance Records.
  • NATCEPs who provide clinical only training to students that have completed the HHSC Classroom Computer Based Training (CBT), must follow the above procedures, check the student’s competency before the beginning of the clinical training, mark the student’s performance in column Classroom* or CBT Online, and attach a copy of the CBT certificate.

Transmittal

Send completed Form 5497-NATCEP, Texas Nurse Aide Performance Record to one of the following:

Texas Health and Human Services Commission Regulatory Services

Mail: 
Nurse Aide Training Program 
PO Box 149030; Mail Code E-420 Austin, Texas 78714-9030

Email:
Regulatory_NATCEP@hhs.texas.gov

Call with any question at 512-438-2017