Sample download
Completion report (sample)
A printable example of the completion record every TPM module produces. Fictional learner and organization.
SAMPLE · Fictional content for illustration only · Not clinical guidance · Not a real learner or organization
Training Completion Report
Generated from the module’s completion screen · Record ID SAMPLE-0001
Sample Home Health Agency
(fictional)
(fictional)
LearnerJordan Sample (fictional)
RoleHome health aide
ModuleFall Prevention Rounding: Home Visits
Versionv1.0 · Policy SAMPLE-CL-031
StartedOct 6, 2026 · 9:02 AM
CompletedOct 6, 2026 · 9:08 AM (6 min 12 s)
Score5 of 5 · 100%
StatusPASSED
Responses
| # | Item | Learner response | Result |
|---|---|---|---|
| 1 | Decision: “I just slipped a little.” | Place walker within reach, ask what happened, report near-fall today | Correct |
| 2 | Decision: the hallway rug | Explain the risk, move it together, document the teaching | Correct |
| 3 | How often is the scan completed? | Every skilled and aide visit | Correct |
| 4 | Same-day reports (select all) | Near-fall; new dizziness; unresolved hazard | Correct |
| 5 | Five points of the scan | Lighting; floors and rugs; cords and clutter; footwear; bathroom | Correct |
Supervisor sign-off
| Behavior | Result | Comment |
|---|---|---|
| Five-point living-path scan | Met | Thorough; checked night lighting |
| Assistive device within reach | Met | |
| Asks about falls and dizziness | Met | |
| Same-day report when indicated | N/A | No event during observation |
| Teaches and documents one correction | Met | Moved a cord out of the path |
Observer: A. Reviewer, RN (fictional) · Date observed: Oct 9, 2026 · 4 met, 0 not met, 1 N/A
Observer signature
Learner signature
Attestation: the learner named above completed this module, and the supervisor observation recorded here reflects direct observation of the listed behaviors. This record supports your documentation of training. It doesn’t by itself certify regulatory compliance.
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