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.
Admit/Orient Involuntary Clients 0★★★★−
Admit/Orient Voluntary Clients 0★★★★−
Advance Directives 0★★★★−
Ambulatory Cuffs 0★★★★−
Assist Activities of Daily Living 0★★★★−
Assist with Personal Hygiene 0★★★★−
Cultural Diversity 0★★★★−
Discharge Clients 0★★★★−
Discharge Planning 0★★★★−
Documentation-Computer 0★★★★−
Documentation-Written 0★★★★−
Full Restraints 0★★★★−
HIPAA Regulations 0★★★★−
Initial Interview 0★★★★−
Initial Screening Assessment 0★★★★−
Isolation Techniques 0★★★★−
Multi-Disciplinary Planning 0★★★★−
Oxygen Administration 0★★★★−
Participate in Interdisciplinary Team 0★★★★−
Patient Teaching 0★★★★−
Reassess/Update Plan of Care 0★★★★−
Referral to Community Resources 0★★★★−
Supervise Unlicensed Personnel 0★★★★−
Vital Signs 0★★★★−
Wrist Restraints 0★★★★−
Anorexia Nervosa 0★★★★−
Bulimia Nervosa 0★★★★−
Obesity 0★★★★−
Interventions/Therapies 0★★★★−
Assaultive Behavior 0★★★★−
Anxiety Disorders 0★★★★−
Bipolar Disorder 0★★★★−
Catatonic Psychotic Disorder 0★★★★−
Delusional Disorders 0★★★★−
Depression 0★★★★−
Dissociative Identity Disorder 0★★★★−
Hallucinations 0★★★★−
Obsessive/Compulsive Disorder 0★★★★−
Panic Attacks 0★★★★−
Paranoid Psychotic Disorder 0★★★★−
Phobias 0★★★★−
Schizophrenia 0★★★★−
Suicidal Ideation/Attempts 0★★★★−
Behavioral 0★★★★−
Couple/Family 0★★★★−
Group 0★★★★−
Individual 0★★★★−
Cluster A-Paranoid/Schizoid 0★★★★−
Cluster B-Antisocial/Borderline 0★★★★−
Cluster C-Anxious/Fearful 0★★★★−
Alzheimer's (Dementia) 0★★★★−
Amnestic Disorders 0★★★★−
Delirium 0★★★★−
Dementia 0★★★★−
Crisis Intervention 0★★★★−
Drug & Alcohol Education 0★★★★−
Education or Vocational Training 0★★★★−
Teach Independent Living Skills 0★★★★−
Therapeutic Communication 0★★★★−
Therapeutic Milieu 0★★★★−
Biofeedback 0★★★★−
ElectroConvulsive Therapy 0★★★★−
Expressive Therapy (Art, Movement) 0★★★★−
Guided Imagery 0★★★★−
Massage Therapy 0★★★★−
Meditation 0★★★★−
Recreational Therapy 0★★★★−
Therapeutic Touch 0★★★★−
Administer IM & SQ Meds 0★★★★−
Administer PO Medications 0★★★★−
Administer Topical Medications 0★★★★−
Identify Appropriate Level of Care 0★★★★−
Discontinue Peripheral IV's 0★★★★−
Pain Assessment/Management 0★★★★−
ADHD 0★★★★−
Alcohol-Related 0★★★★−
Developmental/Autistic Disorders 0★★★★−
Drug-Related 0★★★★−
Mental Retardation 0★★★★−
Post Traumatic Stress Disorder 0★★★★−
Sexual Abuse/Assault 0★★★★−
Sexual Disorders 0★★★★−
Somatoform Disorders (Pain etc.) 0★★★★−
Survivor of Abuse/Violence 0★★★★−
Antianxiety Agents 0★★★★−
Anticholinergics/Antiparkinsons 0★★★★−
Anticonvulsants 0★★★★−
Antidepressants/Mood Elevators 0★★★★−
Antimanic Agents 0★★★★−
Antipsychotic Agents 0★★★★−
Hypnotics 0★★★★−
Management of Med Side Effects 0★★★★−
Recognition of Med Side Effects 0★★★★−
Med-Psych Unit
Transitional Care Hospital
Freestanding Psych Hospital
Community-Based Hospital
Subacute Care Units
Long-Term Care Facilities
Emergency Clinic
Day Treatment Programs
Residential Programs
Home Care
Aftercare/Rehab Clinic
Corrections/Prison
Newborn (birth-30 days) 0★★★★−
Infant (30 days-1 yrs) 0★★★★−
Toddler (1-3 yrs) 0★★★★−
Preschooler (3-5 yrs) 0★★★★−
School Age (5-12 yrs) 0★★★★−
Adolescents (12-18 yrs) 0★★★★−
Young Adults (18-39 yrs) 0★★★★−
Middle Adults (39-64 yrs) 0★★★★−
Older Adults (64 yrs +) 0★★★★−
