F-02067 WIC Staff Training Record Page 6 of 6

DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN Division of Public Health F-02067 (05/2018) Page 1 of 8

WOMEN, INFANTS, AND CHILDREN (WIC) STAFF TRAINING RECORD

A Staff Training Record must be completed for each staff person that works with your Local WIC Project. This form may be copied or expanded. The training record must be uploaded annually by WIC supervisor to Local Project Documents as a part of Program Information Materials and be available for local project Management Evaluation review.

NAME OF EMPLOYEE FIVE YEAR CYCLE

Check the appropriate WIC Role(s), Degrees/Certifications/Certificates (mark all that apply) Registration/ License START DATE Number WIC Director Registered Dietitian (RD, RDN)

WIC Project Nutritionist Dietetic Technician Registers (DTR)

WIC Breastfeeding Coordinator Registered Nurse (RN)

Registered Dietitian CPA (RD,RDN) DATE

Nutritionist CPA (4 year degree) Breastfeeding

Dietetic Technician-Registered CPA (DTR) ADA Weight Management: Adult/Ped

Interpreter Certificate/ WIC Bilingual Certifier Language Proficiency WIC Clerical Support Staff WIC Bilingual Certifier Training

WIC Breastfeeding Peer Counselor Health Screener Training Breastfeeding Peer Counselor (BFPC)

WIC Trainings – Record dates for each session attended WIC All Staff Orientation - Module Overview Module Practice Activity REQUIRED Completed Completed Clinic Observation Demonstration Confidentiality (prior to contact with participants or their information) Policy Overview Common Challenges and Questions ROSIE Security Training (Before using ROSIE) The following trainings must be completed prior to working independently: Civil Rights Mandated Reporting Employee Fraud and Abuse F-02067 – WIC Staff Training Record Page 2 of 8 Blood borne Pathogen Control Using Loving Support to Grow & Glow in WIC (within 1 yr of hire) The following All Staff Modules must be completed within 30 days of hire. Intro to Wisconsin WIC Who Works in WIC Nutrition Education – Improving Health Outcomes Breastfeeding Promotion and Support WIC Foods WIC Vendor Basics Referrals to Health and Social Services Overview of Certification Intake: Proof of Identity, Residency, and Income Income Eligibility Intro to ROSIE - Navigation Intro to ROSIE – Certification OTHER AGENCY REQUIRED TRAININGS DATE DATE

F-02067 – WIC Staff Training Record Page 3 of 8 F-02067 – WIC Staff Training Record Page 4 of 8 ANNUAL REQUIRED TRAININGS Year: DATE DATE

Employee Fraud and Abuse Confidentiality – Policy Overview

Confidentiality – Common Civil Rights – signature on registry required Challenges and Questions

ROSIE Security Training

Blood borne Pathogen Control

Mandated Reporting

ANNUAL REQUIRED TRAININGS Year: DATE DATE

Mandated Reporting

ANNUAL REQUIRED TRAININGS Year: DATE DATE F-02067 – WIC Staff Training Record Page 5 of 8 Employee Fraud and Abuse Confidentiality – Policy Overview

Mandated Reporting F-02067 – WIC Staff Training Record Page 6 of 8 WIC Trainings – Record dates for each session attended

WIC Orientation Module Practice Activity Completed Completed Clinic Observation Demonstration Competent Professional Authority Formula Modules - Overview Introduction to Infant Formula Guidelines for Bottle Feeding Standard Infant Formulas Prescription-Required Formulas for Infants Other Milks Prescription-Required Products for Children Motivational Interviewing Resources Engaging the Client

Open-ended Questioning

Affirming

Reflecting

Summarizing Behavior Change and Resistance to Change What is Important to the Client

Listening for Change Talk

Providing Advice Effectively

Pulling It All Together Local ROSIE Administrator Modules Local ROSIE Administrator Overview Creating and Updating ROSIE User Accounts Administering Clinic Access, Group Memberships, and Project Contacts Creating and Updating Clinic and Site Information Reinforcing ROSIE Security Policies and Training F-02067 – WIC Staff Training Record Page 7 of 8 NAME OF EMPLOYEE/STUDENT FIVE YEAR CYCLE

TRAINING INFORMATION DATE CEU / NAME OF SESSION/OBJECTIVES PRESENTER ATTENDED HOURS

NAME OF EMPLOYEE/STUDENT FIVE YEAR CYCLE

TRAINING INFORMATION DATE CEU / F-02067 – WIC Staff Training Record Page 8 of 8 NAME OF SESSION/OBJECTIVES PRESENTER ATTENDED HOURS