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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)

MM slash DD slash YYYY

AGE OF PATIENTS CARED FOR

Newborn/ Neonate (birth to 30 days)(Required)
Infant (31 days to 12 months)(Required)
Toddler/Preschool (13 months to 5 years)(Required)
School Age Child/adolescent (6 years to 18 years)(Required)
Young Adults Middle Adult (19 years to 64 years)(Required)
Older Adults/Elderly (65+ years)(Required)

GENERAL SKILLS

Care of Patient in Restraints(Required)
Electronic Documentation
Documentation of ADLs, I&O(Required)
Universal Precautions(Required)
Measuring and Documenting Intake and Output(Required)
Standing Scale Patient Weight(Required)
Bed Scale Patient Weight(Required)
Charting(Required)
Bed Making Occupied(Required)
Bed Making Unoccupied(Required)
Code Cart(Required)
Point of Care Blood Glucose Monitoring(Required)
Bed Rails (Putting Up, Down, How to Use)(Required)
Bed Alarm(Required)
Vital Signs(Required)
Hand Hygiene(Required)
Coughing and Deep Breathing(Required)
Dietary Needs(Required)
Urine Specimen Collection-Routine(Required)
Urine Specimen Collection-Clean Catch(Required)
Urine Specimen Collection-12 and 24 Hour(Required)
Stool Specimen Collection(Required)
Reporting Change in Patient Condition(Required)
Dismissal of Patient(Required)
Knowledge of current Joint Commission National Patient Safety Goals(Required)
Knowledge/familiarity with HCAHPS scores(Required)

Activities of Daily Living

Assisting With Ambulation(Required)
Assisting With Toileting(Required)
Bathing of Patient (Shower, Bed Bath)(Required)
Perineal Care(Required)
Back Care(Required)
Positioning of Patient(Required)
Range of Motion Exercises(Required)
Foley Care and Measuring of Output(Required)
Oral Hygiene(Required)
Denture Care(Required)
Skin Care(Required)

WOUND/SKIN-Care of Patient with:

Dressing Changes(Required)
Pressure Relief Mattresses(Required)
Decubitus Ulcers(Required)
Leg Ulcers(Required)

ADDITIONAL SKILLS-Care of Patient With

Hemovacs(Required)
Jackson-Pratt Drains(Required)
Penrose Drains(Required)
Surgical Wound Irrigations & Dressings(Required)

INFECTIOUS DISEASE - Care of the patient with

HIV(Required)
MRSA(Required)
CRE(Required)
VRE(Required)
C. Difficile(Required)
Hepatitis(Required)
Influenza(Required)
Isolation Precautions(Required)
Shingles(Required)
Scabies(Required)

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