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.
Newborn/Neonate (birth to 30 days): 0★★★★−
Infant (1 month to 1 year): 0★★★★−
Toddler (1 year to 3 years): 0★★★★−
Preschooler (3 years to 5 years): 0★★★★−
School Age Child (5 years to 12 years): 0★★★★−
Adolescents (12 years to 18 years): 0★★★★−
Young Adults (18 years to 39 years): 0★★★★−
Middle Adults (39 years to 64 years): 0★★★★−
Older Adults (64 years to 79 years): 0★★★★−
Elderly Adults over 79+ years: 0★★★★−
Hospital: 0★★★★−
Long Term Care: 0★★★★−
Long Term Acute Care: 0★★★★−
Skilled Nursing Units: 0★★★★−
Rehab: 0★★★★−
Standard Precautions: 0★★★★−
Isolation Precautions: 0★★★★−
Pediatric Respiratory / Cardiac Arrest: 0★★★★−
Adult Respiratory / Cardiac Arrest: 0★★★★−
Crash Carts: 0★★★★−
Defibrillators / External Pacing: 0★★★★−
Automated Med Dispensing Systems: 0★★★★−
Please list any additional skills or experiences not covered above:
Blood Cultures: 0★★★★−
Dipstick Urine: 0★★★★−
Sputum: 0★★★★−
Sterile Urine: 0★★★★−
Stool: 0★★★★−
Throat Swab: 0★★★★−
Venipuncture: 0★★★★−
IM and SQ Injections: 0★★★★−
Bedside Invasive Procedures: 0★★★★−
Intubation: 0★★★★−
Lumbar Puncture: 0★★★★−
Abnormal Heart Sounds/Murmurs: 0★★★★−
Auscultation (Rate/Rhythm): 0★★★★−
Capillary Refill: 0★★★★−
Color: 0★★★★−
Acute Myocardial Infarction: 0★★★★−
Angina: 0★★★★−
Cardiac Arrest / Cardiopulmonary Resuscitation: 0★★★★−
Cardiomyopathy: 0★★★★−
Congestive Heart Failure: 0★★★★−
Permanent Pacemaker: 0★★★★−
Internal Defibrillator: 0★★★★−
Cardiac Transplant: 0★★★★−
Pre/Post Cardiac Surgery: 0★★★★−
Abdominal Aortic Aneurysm / Bypass: 0★★★★−
Femoral Popliteal Bypass: 0★★★★−
Myocarditis: 0★★★★−
Post Angioplasty/Stent: 0★★★★−
Thrombophlebitis: 0★★★★−
Chest Pain: 0★★★★−
EKG Monitoring: 0★★★★−
Cardiac Enzymes and Isoenzymes: 0★★★★−
Coagulation Studies: 0★★★★−
BNP: 0★★★★−
Troponin: 0★★★★−
Assess Lung Sounds: 0★★★★−
Rate and Work of Respirations: 0★★★★−
Oxygenation Status: 0★★★★−
Oxygen Delivery Devices: 0★★★★−
Asthma: 0★★★★−
Bronchoscopy: 0★★★★−
Chest Trauma: 0★★★★−
Chest Tubes: 0★★★★−
COPD: 0★★★★−
Laryngospasm: 0★★★★−
Lobectomy: 0★★★★−
Lung Transplant: 0★★★★−
Obstructive Sleep Apnea: 0★★★★−
Pre/Post Thoracic Surgery: 0★★★★−
Pneumonectomy: 0★★★★−
Pneumonia: 0★★★★−
Pneumothorax: 0★★★★−
Pulmonary Edema: 0★★★★−
Pulmonary Embolism: 0★★★★−
Thoracotomy: 0★★★★−
Tracheostomy: 0★★★★−
Tuberculosis: 0★★★★−
Pulse Oximetry: 0★★★★−
Interpretation of ABGs: 0★★★★−
PERRL: 0★★★★−
Level of Consciousness: 0★★★★−
Neurological Assessment: 0★★★★−
Reflex/Motor Deficits: 0★★★★−
Visual / Communication Deficits: 0★★★★−
Stroke Precautions: 0★★★★−
Alzheimer's Disease: 0★★★★−
Coma: 0★★★★−
CVA: 0★★★★−
Halo Traction/Cervical Tongs: 0★★★★−
Intracranial Hemorrhage: 0★★★★−
Laminectomy: 0★★★★−
Neuromuscular Disease: 0★★★★−
Post Craniotomy: 0★★★★−
Seizure Disorder: 0★★★★−
Spinal Cord Injury: 0★★★★−
Pre/Post Neurosurgery: 0★★★★−
Closed Head Injuries: 0★★★★−
Delirium Tremens: 0★★★★−
Encephalitis: 0★★★★−
Meningitis: 0★★★★−
Overdose: 0★★★★−
Guillain Barre Syndrome: 0★★★★−
Externalized AV Shunt: 0★★★★−
Bowel Sounds: 0★★★★−
Nutritional Status: 0★★★★−
GI Assessment: 0★★★★−
GT/PEG Feedings: 0★★★★−
Abdominal Wounds and Surgeries: 0★★★★−
Bowel Obstruction: 0★★★★−
Colostomy: 0★★★★−
GI Bleeding: 0★★★★−
Hepatitis: 0★★★★−
Ileostomy: 0★★★★−
Pancreatitis: 0★★★★−
Paralytic Ileus: 0★★★★−
Post Abdominal Surgery: 0★★★★−
Liver Transplant: 0★★★★−
Inflammatory Bowel Disease: 0★★★★−
Liver Failure: 0★★★★−
Abdominal Trauma: 0★★★★−
Fluid Status: 0★★★★−
Acute Renal Failure: 0★★★★−
End Stage Renal Disease: 0★★★★−
Hemodialysis: 0★★★★−
Peritoneal Dialysis: 0★★★★−
Urinary Tract Infection: 0★★★★−
Suprapubic Catheter: 0★★★★−
Kidney Transplant: 0★★★★−
Insertion of Catheter (Straight/Foley): 0★★★★−
Bladder Irrigations: 0★★★★−
AV Fistula / Shunt Care: 0★★★★−
Nephrostomy Tube: 0★★★★−
Nephrectomy: 0★★★★−
Pyelonephritis: 0★★★★−
TURP: 0★★★★−
Ileal Conduit: 0★★★★−
Renal Trauma: 0★★★★−
Renal Calculi: 0★★★★−
Measurement of I & O: 0★★★★−
Fluid Balance: 0★★★★−
BUN and Creatinine: 0★★★★−
Serum Electrolytes: 0★★★★−
Diabetes Insipidus: 0★★★★−
Diabetes Mellitus: 0★★★★−
Keto Acidosis: 0★★★★−
Diabetic Coma: 0★★★★−
Hyperthyroidism: 0★★★★−
Hypothyroidism: 0★★★★−
Thyroidectomy: 0★★★★−
Blood Glucose: 0★★★★−
Single Type Insulin: 0★★★★−
Mixed Insulins: 0★★★★−
Insulin Infusion: 0★★★★−
Pulses/Circulation Checks: 0★★★★−
Cast Care: 0★★★★−
Crutch Walking: 0★★★★−
Traction: 0★★★★−
Prosthesis Application: 0★★★★−
Assistive Devices: 0★★★★−
Amputation: 0★★★★−
External Fixation: 0★★★★−
Multiple Trauma: 0★★★★−
Paraplegia: 0★★★★−
Rheumatoid Arthritis Disease: 0★★★★−
Joint Replacement: 0★★★★−
Open Reduction Internal Fixation: 0★★★★−
Fractures: 0★★★★−
Spinal Fusion: 0★★★★−
Blood Transfusions: 0★★★★−
Cancer: 0★★★★−
HIV/AIDS: 0★★★★−
Sickle Cell Anemia: 0★★★★−
Acute Leukemia: 0★★★★−
Treatment Side Effects: 0★★★★−
Chemotherapy: 0★★★★−
CRE: 0★★★★−
MRSA: 0★★★★−
C. Difficile: 0★★★★−
Influenza: 0★★★★−
Radiation: 0★★★★−
Sepsis: 0★★★★−
Hematology: 0★★★★−
S/S Infection: 0★★★★−
Skin Assessment: 0★★★★−
Dressing Changes: 0★★★★−
Stump Wrapping: 0★★★★−
Burns and Stages: 0★★★★−
Staged Decubitus Ulcers: 0★★★★−
Stasis Ulcers: 0★★★★−
Arterial Ulcers: 0★★★★−
Suspected Deep Tissue Injuries: 0★★★★−
Multiple Abdominal Wounds and Drains: 0★★★★−
Gunshot Wound: 0★★★★−
Stab Wound: 0★★★★−
Lacerations: 0★★★★−
Traumatic Wounds: 0★★★★−
Pressure Relief Mattresses: 0★★★★−
First Degree Burns: 0★★★★−
Second Degree Burns: 0★★★★−
Third Degree Burns: 0★★★★−
Hemovacs: 0★★★★−
Jackson-Pratt Drains: 0★★★★−
Penrose Drains: 0★★★★−
Surgical Wound Irrigations and Dressings: 0★★★★−
Skin Breakdown: 0★★★★−
Antibiotics: 0★★★★−
Antihypertensives: 0★★★★−
Anticoagulants: 0★★★★−
Anticonvulsants: 0★★★★−
Narcotics: 0★★★★−
Digoxin: 0★★★★−
Diuretics: 0★★★★−
Steroids: 0★★★★−
Diltiazem: 0★★★★−
Antiemetics: 0★★★★−
Antispasmodics: 0★★★★−
Oral Hypoglycemics: 0★★★★−
Inhalers: 0★★★★−
IV Conscious Sedation: 0★★★★−
Reversal Agents (Narcan, Romazicon): 0★★★★−
Please list the EMR systems you have used:
Other Skills: