Download CritiCare Lancaster, Inc. CNA/Home Health Aide Skills Checklist

CritiCare Lancaster, Inc.
CNA/Home Health Aide
Skills Checklist
Directions : Using the key below, check the box that most accurately
describes your level of experience for each skill
A = performed frequently in the last 12 months
B = performed infrequently in the last 12 months
C = not performed in last 12 months but have performed in past years
D =never performed
Area
A B C D
Vital signs: reading and recording temperature, pulse and
respiration
Personal hygiene: including bed bath, sponge, tub or
Shower bath
Hair care: including shampoo – sink , tub, or bed, stying,
Combing and brushing
Oral hygiene: including mouth care and denture care
Nail care: including cleaning and filing nails; foot care
Skin care: including shaving and applying lotion
General grooming : including assisting w/dressing
Toileting and elimination: including BR, commode, urinal,
Bedpan, incontinent care, peri care
Transferring: including transfer to/from chair, wheelchair,
bed
Ambulation: including assisting with ambulation, cane or
Walker, taking clients on walks
Range of motion and positioning: including turning and
Repositioning in bed; dangling, assisting x/ROM or
Exercise program
Maintenance of clean, safe and healthy environment
Including cleaning client area, bedroom, bathroom, or
Kitchen; making bed or changing linens, laundry;
Emptying of urinal/commode
Nutrition and fluid intake: including meal preparation,
Assisting w/feeding, restricting or encouraging fluids
Infection control: including wearing gloves and
Appropriate handling of body fluids
Special treatments: including catheter care, colostomy
Care, dressing changes, or decubitus care (requires
Special training by RN)
Companion services: including talking w/client, reading to
Client, taking to appointments, shopping or on errands
Documentation: including completion of activity reports
And time slips
Understanding the physical, emotional, and
Developmental needs of the client: including conduct that
Respects client, client’s property, and maintaining client
Information in a confidential manner (HIPAA)
Communication skills: including communicating w/client,
Other care givers, and supervisory staff
Area
Recognizing emergencies and emergency procedures:
Including use of EMS system “911”, fire, and/or police
Reporting and documentation of body functioning or
Changes that must be reported to a supervisor: including
Suspicions of abuse
Understanding and delivery of each assigned client’s
Plan of Care
A B C D
CNA or Home Health Aide Certification:
Have you attended and completed a certified nursing
or assistant or home health aide course?
If yes, identify the following:
Location of program:
____Yes ____No
Date of program:
Do you have a current CNA certificate from the
Commonwealth of PA or any other state?
If yes, have you been providing CNA services for a
Continuous period of 24 consecutive months since
Receiving certification?
____Yes ____No
____Yes ____No
Education:
List any other educational experiences that you feel helps you with your work:
Course Name:
Course Location:
Date:
Course Name:
Course Location:
Date:
Course Name:
Course Location:
Date:
Course Name:
Course Location:
Date:
I certify that above information to be true and accurate.
Signature:___________________________________________
Date_____________________