RN Occupational and Employee Health Skills Checklist

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(RN Occupational and Employee Health)

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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

Trauma

Minor Trauma:

★★★★

Major Trauma:

★★★★

MAST Suit:

★★★★

Burns

First Degree:

★★★★

Second Degree:

★★★★

Third Degree:

★★★★

Electrocution:

★★★★

Hazardous Materials Exposure:

★★★★

Lacerations

Assessment:

★★★★

Cleansing:

★★★★

Steri-Strips:

★★★★

Dressing:

★★★★

Sprain/Strain

Assessment:

★★★★

Carpal Tunnel:

★★★★

Tendonitis:

★★★★

Epicondylitis:

★★★★

Physicals

Safety:

★★★★

Return to Work:

★★★★

Respirator:

★★★★

Vital Signs:

★★★★

Height/Weight:

★★★★

Blood Draw:

★★★★

Medical Referral Form:

★★★★

Medical Certification Form:

★★★★

Medical History Questionnaire:

★★★★

Potassium Iodine Assessment:

★★★★

Restrictions

Temporary Restrictions:

★★★★

Permanent Restrictions:

★★★★

Pulmonary Function:

★★★★

Audiometry:

★★★★

Vision Testing:

★★★★

X-ray:

★★★★

Urine Testing:

★★★★

Drug Testing:

★★★★

Breathalyzer:

★★★★

Immunizations

Havrix (Hepatitis A):

★★★★

Influenza Vaccine:

★★★★

Meningitis Vaccine:

★★★★

Tetanus & Diphtheria:

★★★★

Oral Typhoid Vaccine:

★★★★

Polio Vaccine:

★★★★

Hepatitis B Vaccine:

★★★★

Japanese Encephalitis B:

★★★★

Rabies Vaccine:

★★★★

Typhim (Injectable Type):

★★★★

Yellow Fever Vaccine:

★★★★

Age Specific Criteria

Newborn/Neonate (birth–30 days):

★★★★

Infant (30 days–1 year):

★★★★

Toddler (1–3 years):

★★★★

Preschooler (3–5 years):

★★★★

School Age Children (5–12 years):

★★★★

Adolescents (12–18 years):

★★★★

Young Adults (18–39 years):

★★★★

Middle Adults (39–64 years):

★★★★

Older Adults (64+):

★★★★