CNA Skills Checklist

Fill Out and Submit your Skills Checklist

(CNA)

Your name

Your Email

Last 4 Of SSN

Date

E-Signature

I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions:This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

Patient Rights

Communicates and obtains information while respecting HIPAA:

★★★★

Involves patient/family in care decisions including Advance Directives:

★★★★

Complies with Organ Donation policy:

★★★★

Meets communication needs including interpreter services:

★★★★

Provides accurate info to patient/family timely:

★★★★

Vital Signs and Weights

Obtaining and Recording:

BP, including Orthostatic:

★★★★

Pulse, Radial:

★★★★

Temperature, Oral:

★★★★

Temperature, Rectal:

★★★★

Temperature, Axillary:

★★★★

Temperature, Tympanic:

★★★★

Respirations:

★★★★

Weight, Pounds and Kilograms:

★★★★

Recognizing Cardiac Arrest:

★★★★

Activating Code Team:

★★★★

Bringing Emergency Equipment to Room:

★★★★

Providing Appropriate Code Support:

★★★★

Use of Electronic VS equipment:

Automatic BP machine (Dynamap):

★★★★

Electronic Thermometer:

★★★★

Applying Oximeter:

★★★★

Scale Use:

Standing:

★★★★

Chair:

★★★★

Bed:

★★★★

GI / GU:

Report Abnormal Findings:

★★★★

Bowel Function:

★★★★

Bladder Function:

★★★★

Administering Enemas:

Tap Water:

★★★★

Fleets:

★★★★

Return Flow:

★★★★

Placing and Removing Bed Pan:

★★★★

Clamping Catheter:

★★★★

Emptying Foley Bag:

★★★★

Placing Condom Catheter:

★★★★

Emptying and Replacing Ostomy Bag (Established Ostomy):

★★★★

Nutrition

Estimating Intake:

★★★★

Setting up for Meals:

★★★★

Feeding Patients:

★★★★

Aspiration Precautions:

★★★★

Nourishments:

★★★★

Counting Calories:

★★★★

Fluid Restriction:

★★★★

NPO:

★★★★

Specimens

Collecting Stool:

★★★★

Collecting Sputum:

★★★★

Labeling Specimens and Preparing for Transport:

★★★★

Collecting Urine:

Clean Catch:

★★★★

24 Hour:

★★★★

Hygiene /Skin

Risk Factors for Skin Breakdown:

★★★★

Observing Pressure Points for Redness or Breakdown:

★★★★

Bathing /Daisy Hygiene:

Bathing (Shower /Tub /Arjo):

★★★★

Oral Care, Including Patients who are NPO, Comatose, Patients with:

★★★★

Pen Care:

★★★★

Foot Care for Patients with Impaired Circulation or Sensation:

★★★★

Incontinence Care:

★★★★

Shaving and Precautions:

★★★★

Reducing Pressure and Friction:

★★★★

Use of Pressure and Friction Reduction Devices:

Special Beds/Mattresses:

★★★★

Heels and Elbow Protection:

★★★★

Foot Cradles:

★★★★

Use of Shower Chair:

★★★★

Use of Bath/Shower Boat:

★★★★

Infection Control

Reverse Isolation:

★★★★

Body Substance isolation:

★★★★

TB Precautions:

★★★★

MRSA Precautions:

★★★★

Hand Washing:

★★★★

Infectious/Hazardous Waste Disposal:

★★★★

Supply/Equipment Disposal:

★★★★

Use of Disposable Thermometer:

★★★★

Use of CPR Mask/Bag:

★★★★

Proper use of Specific Barrier, Methods:

Gloves:

★★★★

Gown:

★★★★

Mask / Goggles:

★★★★

Safety and Activity

Determining Patient ID:

★★★★

Identifying Safety Hazards:

★★★★

Determining Need for Additional Help:

★★★★

Assessing Safety and ADL Needs:

★★★★

Assessing Safety and ADL Needs:

★★★★

Recognizing Abuse: Substance, Physical, Emotional, etc:

★★★★

Maintaining Clean, Orderly Work Area:

★★★★

Disposing of Sharps:

★★★★

Handling Hazardous Materials:

★★★★

Proper Body Mechanics:

★★★★

ROM Exercises:

★★★★

Transferring to Bed, WC, Commode, etc:

★★★★

Turning and Positioning:

★★★★

Patient Safety Module:

★★★★

Reporting Broken Equipment:

★★★★

Responding to Safety Hazards:

★★★★

Use of HoyerLift (Dextra /Maxi):

★★★★

Bed Operation:

★★★★

Use of Wheel Locks:

★★★★

Use of Alarms: Bed, Patient, Unit:

★★★★

Use of Call Light:

★★★★

Documenting Use of Restraints:

★★★★

Use of Transfer Belt:

★★★★

Use of Gait Belt for Ambulation:

★★★★

Use of Seizure Pads:

★★★★

Application of Restraints:

Belt Including Seat Belt:

★★★★

Wrist/Ankle:

★★★★

Vest:

★★★★

Care Routines

New Admissions and Transfers:

Inventory and Disposition of Belongings, Use of Checklist:

★★★★

Room Orientation, Call Bell:

★★★★

Post-op Patients:

Transferring into Bed:

★★★★

Call Bell:

★★★★

Assist with Turns:

★★★★

ROM Exercises:

★★★★

Maintaining O2 Therapy:

Replacing Mask or Nasal Cannula if Needed:

★★★★

Notifying Nurse of Problems:

★★★★

Basic Comfort Measures:

★★★★

Preparation For and Transfer to SNF:

Early Bath:

★★★★

Preparing Belongings:

★★★★

Preparing for and Explaining Routines to Patient:

★★★★

Post Mortem Care:

★★★★

Use of Incentive Spirometer:

★★★★

Removing /Replacing:

Antiembolic Stockings:

★★★★

Sequential Stockings:

★★★★

Communication

Using Appropriate Abbreviations:

★★★★

Identifying Unusual Patient Incidents that Require Reporting:

★★★★

Reinforcing RN Teaching With Patient:

★★★★

Selecting and Using Forms Appropriately:

★★★★

Using Alternate Communication Tools/Devices:

★★★★

Communicating to RN:

Changes in Patient Condition:

★★★★

Patient Needs, Complaints and Concerns:

★★★★

Unusual Incidents:

★★★★

Recording and Reporting:

Vital Signs:

★★★★

Bathing /Hygiene:

★★★★

Turning and Repositioning:

★★★★

Ambulation and Activity:

★★★★

Diet intake, Calorie Count:

★★★★

Bowel Movements:

★★★★

1 & 0:

Shift Volumes and Totals:

★★★★

Marking and /or Measuring Amount of Urine, Gastric Fluid, NG Drainage, Emesis, Diarrhea:

★★★★

Age Specific Competencies

Infant (Birth - 1 year):

★★★★

Preschooler (ages 2-5 years):

★★★★

Childhood (ages 6-12 years):

★★★★

Adolescents (ages 13-21 years):

★★★★

Young Adults (ages 22-39 years):

★★★★

Older Adults (ages 65-79 years):

★★★★

Adults (ages 40-64 years):

★★★★

Elderly (ages 80+ years):

★★★★

Unit Activity

Identifying Unusual Incidents on the Unit that Require Reporting:

★★★★

Locating and Using Appropriate Reference Materials: Hospital, Patient Care and:

★★★★

Charging for Patient Care Items:

★★★★

Completing Risk Management Reports as Needed:

★★★★

Obtaining Needed Supplies and Equipment:

★★★★

Reporting and Following up on Faulty Equipment and Supplies:

★★★★

Using Telephone System:

★★★★