Quality and Risk Management 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 / Observed Only

2 Limited Experience / Rarely Done (<6 times/year)

3 May Need Some Review / Occasionally Done (1 - 2 times/month)

4 Experienced / Frequently Done (daily or weekly)

Age Of Patients Cared For

Newborn/Neonate (birth to 30 days)

Infant (1 month to 1 year)

Toddler (1 year to 3 years)

Preschooler (3 years to 5 years)

School Age Child (5 years to 12 years)

Adolescents (12 years to 18 years)

Young Adults (18 years to 39 years)

Middle Adults (39 years to 64 years)

Older Adults (64 years to 79 years)

Elderly Adults (over 79+ years)

Skilled Environments

General Risk/quality

Experience

Please list any additional areas of expertise below:

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.