Skills Checklist – House Supervisor

Skills Checklist – House Supervisor

• Name
  
  First
  
  Last
• Phone
• Email
  
• GENERAL SKILLS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Standard Precautions
  Isolation Precautions
  Working with patients in restraints
  Patient/Family Education
  Patient Identification
  Specialty Beds
  End of Life/Palliative Care
  Collect Appropriate Data
  Knowledge of current Joint Commission National
  Electronic Documentation

• GENERAL SKILLS – TYPES OF ELECTRONIC DOCUMENTATION:(if applicable)
• SETTING*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Acute Care/Hospital
  SNF/Long Term Care
  Managed Care
  Home Health
  Hospice
  Outpatient
  Physician Office

• MANAGEMENT*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Understanding of health care economics and health care policies as it applies to patient care
  Concepts of capital budgeting
  Department/Unit budgeting
  Recruitment techniques
  Interviewing techniques
  Labor laws pertaining to hiring
  Orientation of new employees
  Knowledge of quality improvement/performance improvement tools
  Patient Safety
  Workplace Safety
  Promotion of interdepartmental communication
  Performance management
  Staff development
  Coaching and mentoring
  Project managemenet
  Business development
  Developing strategic plans
  Cultural competence
  Ethical behavior and practice
  Professional association involvement
  Conflict management
  Team dynamics
  JCAHO standards
  OSHA standards
  Risk Management/Service Utilization
  Local Department of Health
  State Department of Health
  Sitter services

• Please list other skills:(if applicable)
• 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