Skills Checklist – CNA

Skills Checklist – CNA

• Name
  
  First
  
  Last
• Phone
• Email
  
• SKILL*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Assist with Admission of Patient
  Assist with Ambulation
  Assist with bedpan/urinal/commode
  Backrubs/ Back care
  Basic Medical Asepsis
  Bathing: Complete/Partial/Sitz
  Bed Cradles
  Bed Making- occupied/unoccupied/surgical
  Bed Rails: when/how to use them
  Cast Care
  Charting/ Checklist/Graphic Charts
  Compresses: Warm/ Cold
  Coughing/ deep breathing
  CPR
  Crutch Walking: Assist Patient
  Dangling Patient
  Diabetic Testing
  Dietary Restrictions
  Documentation: vital signs, I & O
  Documentation of Patient’s Belongings
  Douches
  Elastic Stockings (AE hose)
  Elimination Check & Record
  Enemas, Rectal Tubes, Harris Flush
  Fall Precautions
  Feed Patient
  Foley Catheter Care & Emptying
  Footboard
  Glucometer
  Hand Hygiene
  Height: Measure & Record
  Intake & Output Measure & Record
  Orthostatic Blood Pressure
  Transfers
  Use of Assistive Devices
  Vital Signs
  Weight: Measure and Record
  Electronic Documentation

• List Types of Electronic Documentation: (if applicable)
• SPECIMEN COLLECTION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Routine Urine
  Clean Catch
  12 & 24- hour Specimen
  Stool
  Culture
  Sputum
  From Foley Catheter

• INFECTION CONTROL PRECAUTIONS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Standard Universal Precautions
  Reverse Isolation
  TB / Airborne Precautions
  MRSA / VRE Precautions
  Nourishment for Patients
  Observing Patients
  Oral Hygiene
  Patient Safety Standards/Precautions
  Perineal Care
  Positioning Patients
  Prosthetic Devices (care of dentures, contact lenses, etc)
  Range of Motion Exercises
  Reporting Changes of Patient Condition
  Reporting/ Recording of Patient’s Pain Level
  Restraints
  Skin Care

• Personal

• Age Group Experience*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Newborn (birth – 30 days)
  Infant (30 days – 1 year)
  Toddler (1 – 3 years)
  Preschooler (3 – 5 years)
  School Age (5 – 12 years)
  Adolescents (12 – 18 years)
  Young Adults (18 – 39 years)
  Middle Adults (39-64 years)
  Older Adults (64+ years)

• Do you speak any languages other than English?*
  • No

  If yes, enter languages above, separated by commas.

• Confirmation*
  • 
    I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
• Signature
• Date
  
  Date Format: MM slash DD slash YYYY