Acute Rehab RN Skills Checklist

Personal Information

Please fill the Recruiter Email correctly for successful application submission.

Candidate Name

Email of Recruiter / POC

Select Submission Date

SSN (Last 4 digits)

Proficiency Scale & Legend

1 No experience; Theory/observed only

2 Acceptable competency; > 5 times per year

3 Limited competency; < 5 times per year; Needs supervision

4 Competent; Performs on a daily or weekly basis; Proficient

Work Settings

General Acute Care

Home Health

Nursing Home

Outpatient Clinic

Pediatric Rehab

Acute Rehab Hospital

Rehab Unit in Hospital

Neuro

Ortho

Restraints

Emr

Pulmonary

Pediatrics

Nutritional Requirements

Other

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency.