NURSESTAT CNA SKILLS CHECK
Name
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Date
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Skills- Check the level of experience
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Theory, no practice
Limited
Confident
Very Confident
Provide AM and PM Care
Assist with Bathing( bed, tub and shower),:
Assist with Patient Ambulation
Provide Skin Care
Provide Oral Care
Provide Peri Care
Care of patient with Foley
Care of patient with ostomy
Standard Precautions
Hand-washing/Hand Hygiene
Isolation technique
Apply Cool Compresses
Calculate/Measure Intake and Output
Assist with ROM Exercises
Application of TED hose
Provides appropriate. Menu to patient
Shave Patient
Provide Post Mortem Care
Takes Vital Signs: TPR, B/P
Weights patients, various scales
Use of Side Rails
Transfer/transport Patient
Specimen Collection
Follow Fluid restrictions
Use of Special Mattresses
Admit/Discharge Patient
Proper Phone Etiquette
Long Term Care Experience
Hospital Experience
Home Health Experience
Private Sitter Experience
Knowledgeable of fall prevention techniques
Reports changes in patient condition,
Abuse/Neglect Procedures and Reporting
Signature :
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By signing this form I acknowledge i can perform these skills
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