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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_____________________