Nursing Assistant/CNA 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

2 Limited Experience

3 Experienced

4 Highly Skilled

Patient Rights

Communicates and obtains information while respecting the rights and privacy and confidentiality of information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Involves the patient and family and respects their role in determining the nature of care to be provided, including Advance Directives.

Complies with nursing staff responsibility included in the hospital policy related to Organ Donation.

Meets patient and family’s needs regarding communication, including interpreter services.

Provides accurate information to patient and families in a timely manner.

Vital Signs And Weights:

Use Of Electronic Vs Equipment:

Scale Use:

Gi /gu:

Administering Enemas:

Vital Signs And Weights:

Nutrition:

Specimens:

Collecting Urine:

Clean Catch

24 Hour

Hygiene /skin:

Use Of Pressure And Friction Reduction Devices:

Infection Control:

Proper Use Of Specific Barrier, Methods:

Safety And Activity:

Applicationof Restraints:

Care Routines: New Admissions And Transfers:

Communication

Unit Activity:

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.