Lpn Skills Competency 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 No Experience. Theory Only.

2 Limited competency / proficiency

3 Acceptable competency / proficiency

4 Competent / proficient/ Performed frequently

Skills

Activities of Daily Living Infection Control Precautions

Admission of Patient Standard Universal Precautions

Administration of Medication Reverse Isolation

Ambulation TB / Airborne Precautions

Application of Heat and Cold MRSA / VRE Precautions

Aseptic Technique Isolation procedure for specimen collection

Assist with Medical Examination IVs: Monitor Rate & Infusion Site

Bathing: Sitz, Tub, Bed & Shower

Medications: Oral, IM, Subcutaneous

Bandaging Mouth Care

Binders Nail Care

Body Alignment Neurological Check

Body Systems Review (Head to Toe Data Collection) Nutritional Needs

Cast Care Observations

Catheterization / Foley Catheter Insertion Response to treatment/meds

Charting Signs of Significant Body System Changes

Colostomy Care & Irrigation Signs of shock

CPR Signs of Pain

Crutch Walking Observes Safety Procedures

Decubitus Care O2 Administration

Diabetic Blood Glucose Testing Pain Assessment

Diagnostic Tests & Preparation of Forms Patient Care Plans (Revise & Update)

Discharge Patients Patient Safety Standards / Precautions

Dosage Computation Positioning Patient

Draping Postural Drainage

Dressing (Sterile) Pre-Op & Post-Op Care

Ear Drops Provide Comfort, Safety & Privacy

Elimination Needs Pulse Oxymetry

Enemas, cleansing, retention, Harris

Flush Range of Motion

Hand Hygiene Report Observations / Changes

Do you speak any other language(s) besides English? Yes / No If YES, please list other language(s)

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Are you familiar with computer charting? Yes / No If YES, what system(s) have you used:

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Comments

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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.