CNA Skills Checklist

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:

1 = No Experience (Theory or observation only during the past 12 months)

2 = Limited Experience (Performed less than 12 times within the past 12 months and may need a review)

3 = Experienced (Performed at least once per month within the past 12 months and may need minimal assistance)

4 = Highly Skilled (Performed on at least a weekly basis over the past 12 months; proficient)

MM slash DD slash YYYY
Blood Glucose Monitoring
Measure and Record I & O
Measure Blood Pressure
Measure Orthostatic BP
Measure Pulse
Measure Respirations
Measure Temperature – Axillary
Measure Temperature – Oral
Measure Temperature – Rectal
Measure Temperature - Tympanic
Administer Enemas
Bed Making Occupied
Bed Making Unoccupied
Bedside Commode
Care of a Combative Patient
Care of a Confused Patient
Care of a Suicidal Patient
Complete Bed Bath
Denture Care
Foley Care
Foot Care
Oral Hygiene
Post Mortem Care
Provide Perineal Care
Range of Motion
Shower with Assistance
By submitting this checklist, I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.