Skills Checklist: CNA

Skills Checklist – CNA

This self-evaluation is for assessing your experience in specific clinical areas. This self-evaluation will not be a determining factor in accepting your application to become an employee of Connected Health Care.

0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced

SKILL(Required)

	0	1	2	3	4	5
Assist with Admission of Patient
Assist with Ambulation
Assist with bedpan/urinal
Backrubs/ Back care
Basic Medical Asepsis
Bathing: Complete/Partial/Sitz
Bed Cradles
Bed Making- occupied/unoccupied
Bed Rails: when/how to use them
Cast Care
Charting/ Checklist/Graphic Charts
Compresses: Warm/ Cold
Coughing/ deep breathing
CPR
Crutch Walking: Assist Patient
Dangling Patient
Diabetic Testing
Dietary Restrictions
Documentation: vital signs, I & O
Documentation of Patient’s Belongings
Douches
Elastic Stockings (AE hose)
Elimination Check & Record
Enemas, Rectal Tubes, Harris Flush
Fall Precautions
Feed Patient
Foley Catheter Care & Emptying
Footboard
Glucometer
Hand Hygiene
Height: Measure & Record
Intake & Output Measure & Record
Orthostatic Blood Pressure
Transfers
Use of Assistive Devices
Vital Signs
Weight: Measure and Record
Electronic Documentation

SPECIMEN COLLECTION(Required)

INFECTION CONTROL PRECAUTIONS(Required)

	0	1	2	3	4	5
Standard Universal Precautions
Reverse Isolation
TB / Airborne Precautions
MRSA / VRE Precautions
Nourishment for Patients
Observing Patients
Oral Hygiene
Patient Safety Standards/Precautions
Perineal Care
Positioning Patients
Prosthetic Devices (care of dentures, contact lenses, etc)
Range of Motion Exercises
Reporting Changes of Patient Condition
Reporting/ Recording of Patient’s Pain Level
Restraints
Skin Care

Name

First Last

Date

Specialty

By Signing this, I am authorizing that the information I have given is true and accurate to the best of my knowledge. I hereby authorize Connected Health Care to release this Skills Checklist to staffing clients of Connected Health Care. Submit this skills evaluation with your initial application.

Signature(Required)

	0	1	2	3	4	5
Routine Urine
Clean Catch
& - hour Specimen
Stool
Culture
Sputum
From Foley Catheter