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SCHOOLS
TELEPRACTICE

About Us
Employees
Employers
Contact
Blog

HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

Certified Nursing Assistant Skills Checklist

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only

1 = Limited Experience / Rarely Done (<6 times/year)

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

3 = Experienced / Frequently Done (daily or weekly)

"*" indicates required fields

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Full Name*

Email*

Todays Date*

MM slash DD slash YYYY

Age Of Patients Cared For

Newborn/Neonate (birth to 30 days)

0

1

2

3

Infant (31 days to 12 months)

0

1

2

3

Toddler/Preschool (13 months to 5 years)

0

1

2

3

School Age Child/adolescent (6 years to 18 years)

0

1

2

3

Young Adults/Middle Adult (19 years to 64 years)

0

1

2

3

Older Adults/Elderly (65+ years)

0

1

2

3

General Skills

Care of Patient in Restraints

0

1

2

3

Electronic Documentation

Allscripts

Care360

Cerner

eCLinicalWorks

EPIC

MACLAB

McKesson

Meditech

PACS

Soarian

N/A

Other Electronic Documentation:

Documentation of ADLs, I&O

0

1

2

3

Universal Precautions

0

1

2

3

Measuring and Documenting Intake and Output

0

1

2

3

Standing Scale Patient Weight

0

1

2

3

Bed Scale Patient Weight

0

1

2

3

Charting

0

1

2

3

Bed Making Occupied

0

1

2

3

Bed Making Unoccupied

0

1

2

3

Code Cart

0

1

2

3

Point of Care Blood Glucose Monitoring

0

1

2

3

Bed Rails (Putting Up, Down, How to Use)

0

1

2

3

Bed Alarm

0

1

2

3

Vital Signs

0

1

2

3

Hand Hygiene

0

1

2

3

Coughing and Deep Breathing

0

1

2

3

Dietary Needs

0

1

2

3

Urine Specimen Collection-Routine

0

1

2

3

Urine Specimen Collection-Clean Catch

0

1

2

3

Urine Specimen Collection-12 and 24 Hour

0

1

2

3

Stool Specimen Collection

0

1

2

3

Reporting Change in Patient Condition

0

1

2

3

Dismissal of Patient

0

1

2

3

Knowledge of current Joint Commission National Patient Safety Goals

0

1

2

3

Knowledge/familiarity with HCAHPS scores

0

1

2

3

Activities Of Daily Living

Assisting With Ambulation

0

1

2

3

Assisting With Toileting

0

1

2

3

Bathing of Patient (Shower, Bed Bath)

0

1

2

3

Perineal Care

0

1

2

3

Back Care

0

1

2

3

Positioning of Patient

0

1

2

3

Range of Motion Exercises

0

1

2

3

Foley Care and Measuring of Output

0

1

2

3

Oral Hygiene

0

1

2

3

Denture Care

0

1

2

3

Skin Care

0

1

2

3

Wound/skin-care Of Patient With:

Dressing Changes

0

1

2

3

Pressure Relief Mattresses

0

1

2

3

Decubitus Ulcers

0

1

2

3

Leg Ulcers

0

1

2

3

Additional Skills-care Of Patient With

Hemovacs

0

1

2

3

Jackson-Pratt Drains

0

1

2

3

Penrose Drains

0

1

2

3

Surgical Wound Irrigations & Dressings

0

1

2

3

Infectious Disease - Care Of The Patient With

HIV

0

1

2

3

MRSA

0

1

2

3

CRE

0

1

2

3

VRE

0

1

2

3

C. Difficile

0

1

2

3

Hepatitis

0

1

2

3

Influenza

0

1

2

3

Isolation Precautions

0

1

2

3

Shingles

0

1

2

3

Scabies

0

1

2

3

awards updated 2022

SIA_CM_Member_2018

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