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.
BP, including Orthostatic 0★★★★−
VITAL SIGNS AND WEIGHTS 0★★★★−
Administering an Enema 0★★★★−
Applying Ted Hose 0★★★★−
Assessing Respirations 0★★★★−
Assisting with Ambulation 0★★★★−
Assist with Dressing 0★★★★−
Colostomy Care 0★★★★−
Denture Care 0★★★★−
EKG 0★★★★−
Incentive Spirometer 0★★★★−
Isolation Techniques 0★★★★−
Making an Unoccupied Bed 0★★★★−
Making an Occupied Bed 0★★★★−
Massaging 0★★★★−
Measuring Height 0★★★★−
Measuring Intake and Output 0★★★★−
Moving the Patient 0★★★★−
Mouth Care 0★★★★−
Perineal Care 0★★★★−
Phlebotomy 0★★★★−
Placing Restraints 0★★★★−
Positioning the Patient 0★★★★−
Postmortem Care 0★★★★−
Range of Motion 0★★★★−
Sterile Technique 0★★★★−
Transferring the Client 0★★★★−
Universal Precautions 0★★★★−
Using a Mechanical Lift 0★★★★−
Recognizing Cardiac Arrest 0★★★★−
Activating Code Team 0★★★★−
Bringing Emergency Equipment to Room 0★★★★−
Providing Appropriate Code Support 0★★★★−
GI/GU 0★★★★−
Report Abnormal Findings 0★★★★−
Bowel Function 0★★★★−
Bladder Function 0★★★★−
Placing and Removing Bed Pan 0★★★★−
Clamping Catheter 0★★★★−
Emptying Foley Bag 0★★★★−
Placing Condom Catheter 0★★★★−
Emptying and Replacing Ostomy Bag (Established Ostomy) 0★★★★−
Apical 0★★★★−
Radial 0★★★★−
Axillary 0★★★★−
Oral 0★★★★−
Rectal 0★★★★−
Tympanic 0★★★★−
Buccal 0★★★★−
Topical 0★★★★−
Vaginal 0★★★★−
Chair 0★★★★−
Bed 0★★★★−
Sliding Scale 0★★★★−
Automatic BP machine (Dynamap) 0★★★★−
Electronic Thermometer 0★★★★−
Applying Oximeter 0★★★★−
Tap Water 0★★★★−
Fleets 0★★★★−
Return Flow 0★★★★−
Estimating Intake 0★★★★−
Setting up for Meals 0★★★★−
Feeding Patients 0★★★★−
Aspiration Precautions 0★★★★−
Nourishments 0★★★★−
Counting Calories 0★★★★−
Fluid Restriction 0★★★★−
NPO 0★★★★−
Collecting Stool 0★★★★−
Collecting Sputum 0★★★★−
Labeling Specimens and Preparing for Transport 0★★★★−
Clean catch 0★★★★−
24 hour 0★★★★−
Risk Factors for Skin Breakdown 0★★★★−
Observing Pressure Points for Redness or Breakdown 0★★★★−
Bathing (Shower/Tub/Arjo) 0★★★★−
Oral Care, including Patients who are NPO, Comatose 0★★★★−
Pen Care 0★★★★−
Foot Care for Patients with Impaired Circulation or Sensation 0★★★★−
Incontinence Care 0★★★★−
Shaving and Precautions 0★★★★−
Reducing Pressure and Friction 0★★★★−
Special Beds/Mattresses 0★★★★−
Heels and Elbow Protection 0★★★★−
Foot Cradles 0★★★★−
Use of Shower Chair 0★★★★−
Use of Bath/Shower Boat 0★★★★−
Reverse Isolation 0★★★★−
Body Substance Isolation 0★★★★−
TB Precautions 0★★★★−
MRSA Precautions 0★★★★−
Hand washing 0★★★★−
Infectious/Hazardous Waste Disposal 0★★★★−
Supply/Equipment Disposal 0★★★★−
Use of Disposable Thermometer 0★★★★−
Use of CPR Mask/Bag 0★★★★−
Gloves 0★★★★−
Gown 0★★★★−
Mask/Goggles 0★★★★−
Determining Patient ID 0★★★★−
Identifying Safety Hazards 0★★★★−
Determining Need for Additional Help 0★★★★−
Assessing Safety and ADL Needs 0★★★★−
Recognizing Abuse: Substance, Physical, Emotional etc 0★★★★−
Maintaining clean, orderly work area 0★★★★−
Disposing of Sharps 0★★★★−
Handling hazardous materials 0★★★★−
Proper body mechanics 0★★★★−
ROM Exercises 0★★★★−
Transferring to bed, WC, Commode etc 0★★★★−
Turning and positioning 0★★★★−
Patient Safety Module 0★★★★−
Reporting Broken Equipment 0★★★★−
Responding to Safety Hazards 0★★★★−
Use of HoyerLift (Dextra/Maxi) 0★★★★−
Bed Operation 0★★★★−
Use of Wheel Locks 0★★★★−
Use of Alarms: Bed, Patient, Unit 0★★★★−
Use of Call Light 0★★★★−
Documenting Use of Restraints 0★★★★−
Use of Transfer Belt 0★★★★−
Use of Gait Belt for Ambulation 0★★★★−
Use of Seizure Pads 0★★★★−
Belt including seat belt 0★★★★−
Wrist/Ankle 0★★★★−
Vest 0★★★★−
Newborn (birth to 30 days) 0★★★★−
Infant (31 days to 1 year) 0★★★★−
Toddler (ages 2-3 years) 0★★★★−
Preschooler (ages 4-5 years) 0★★★★−
Childhood (ages 6-12 years) 0★★★★−
Adolescents (ages 13-21 years) 0★★★★−
Young Adults (ages 22-39 years) 0★★★★−
Adults (ages 40-64 years) 0★★★★−
Older Adults (ages 65-79 years) 0★★★★−
Elderly (ages 80+ years) 0★★★★−
