Home Health Aide Skills Checklist

Candidate Self Assessment

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 I can perform well

2 I need to review

3 I have no experience

Skills

Communication

Observation, reporting and documentation of patient status and the care of services provided

Reading and recording temperature, pulse and respiration

Universal Precautions

Basic elements of body functions and changes in condition that must be reported

Maintaining a clean, safe and health environment

Ability to recognize emergency situations

Ability to recognize physical and emotional needs and work with the client and respect the pt’s privacy and property

Bed Bath

Sponge Bath

Shampoo (sink, tub or bed)

Nail Care

Skin Care

Oral Hygiene

Toileting and elimination

Safe transfer techniques

Safe Ambulation

Normal positioning with proper body alignment

Ability to recognize adequate nutrition and intake

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.