CNA KNOWLEDGE & SKILLS CHECKLIST

NAME:      
ID #:       DIRECTIONS: Please indicate your level of
DATE:       experience by placing a check (√) in the
box. Experience level:
This Skills Checklist is for use by nurses 1 NO EXPERIENCE
with more than one year experience in 2 MINIMAL EXPERIENCE-requires
their discipline and specialty. Please be supervision/assistance
accurate with your assessment. 3 MODERATELY EXPERIENCED-requires
DESCRIPTION 1 2 3 4 initial review, then performs
Admitting a Patient independently
Discharging a Patient 4 VERY EXPERIENCED- proficient
Ambulating a Patient
Hand washing
DESCRIPTION 1 2 3 4
HIPPA (Privacy)
Bathing:
Patients Bill of Rights
Complete Bed Bath
Universal Precautions
Bed Shampoo
Charting:
Partial Bed Bath
Graphic
Shaving a patient
Flow sheet
Showering a patient
Computer
Showering w/ chair
Progress Notes
Tub Bath
Blood Pressure
Hoyer lift
Choking
Gait Belt
CPR
Transfer:
Intake & Output (I&O)
Traction
Oral Hygiene
Bed to Chair
Oral Suctioning
Bed to Commode
Pulse
Bed to Stretcher
Respirations
Bed to WC
Temperature:
Psychiatric:
Apical
Care of a Combative Patient
Axillary
Care of a Suicidal Patient
Centigrade
Care of a Confused Patient
Fahrenheit
Behavior Modification
Rectal
Preventing Patient Harm
Weights:
Preventing Personal harm
Bed Scale
Obtaining Assistant to Prevent
Chair Scale
Crisis
Stand up Scale
Care of the Patient with:
Bed Making:
Cast Care
Unoccupied
Back Care
Occupied
Colostomy Care
Post-op
Decubiti-Care
Range of Motion:
Gastrostomy Care
Active
Perineal Care
Passive
Tracheostomy Care
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 CNA KNOWLEDGE & SKILLS CHECKLIST
Other:
Enema (Fleets)

Name:
DESCRIPTION 1 2 3 4
Enema (Other)
Rectal Tubes
Hypothermia Blanket
O2 Administration
Isolation Techniques
Use of Restraints ID #:      
K-Pads
Types of Facilities that you have worked in: I HAVE CURRENT CERTIFICATIONS FOR:
Adult Day Care
TYPE
Ambulatory Clinic
EXPIRATION (MM/DD/YY)
Home Care
Health Care Worker      
Hospital
CPR
Long Term Care Facility
Health Care Worker      
Mental Health
BLS
Pediatric Day Care
NRP      
ACLS      
Please check the boxes below for each
Basic First Aid      
age group for which you have expertise in
Medication      
providing age-appropriate nursing care.
Certification
Other            
A. Newborn/Neonatal (birth – 30 days) Y N
Other            
B. Infant (30 days – 1 year) Y
N
C. Toddler (1 – 3 years) Y
The information I have provided in this
N
knowledge and skills checklist it true and
D. Preschool (3 – 5 years) Y
accurate to the best of my knowledge.
N
E. School Age Children (5 – 12 years) Y
           
N
Signature Date
F. Adolescent (12 – 18 years) Y (Written/Electronic)
N
ID #:      
G. Young Adults (18 – 39 years) Y
N
This skills checklist has been reviewed
H. Middles Adults (40 – 64 years) Y and approved by Nicole Bloxham, RN.
N
I. Older Adults (64 + years) Y            
N
Signature Date
(Written/Electronic)
ID #:      

Please return to: Northwest Nurse Staffing

Company, PA
ATTN: Records Dept.

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 CNA KNOWLEDGE & SKILLS CHECKLIST
Fax: (866) 352-4338

Email: records@nns-ic.com

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