[checklist name= "Certified Nursing Assistant" mailto="credentialing@teemagroup.com" templatedoc="1T8O1jhdlpYF8qjwbNMy6e54tinSeU7dngUKVTbufIgg" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Certified Nursing Assistant"] Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below) 0 = No theory and/or experience 1 = Limited experience/need supervision and/or support 2 = Experienced/minimal support needed to perform) 3 = Proficient/can perform independently 4 = Expert/very experienced in the field [/checklistHeading] [checklistInputGroup name="Recruiter Information"] [checklistInput type="email"]Recruiter TEEMA email[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Personal Information"] [checklistInput type="text"]Full Name[/checklistInput] [checklistInput type="email"]Your Email[/checklistInput] [checklistInput type="text"]Your phone number[/checklistInput] [checklistInput type="text"]Last 4 of Social Security Number[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Age Specific Competency"] [checklistInput type="scale"]Neonates/Newborns (0-30 days)[/checklistInput] [checklistInput type="scale"]Infant (30 days-1year)[/checklistInput] [checklistInput type="scale"]Toddler (1-3 years)[/checklistInput] [checklistInput type="scale"]Preschool Child (3-5 years)[/checklistInput] [checklistInput type="scale"]Older Child (5-12 years)[/checklistInput] [checklistInput type="scale"]Adolescents (12-18 years)[/checklistInput] [checklistInput type="scale"]Young adult (18-39 years)[/checklistInput] [checklistInput type="scale"]Middle adult (39-64)[/checklistInput] [checklistInput type="scale"]Older adult (64+ years)[/checklistInput] [checklistInput type="scale"]Able to adapt care to age of normal growth and development[/checklistInput] [checklistInput type="scale"]Able to adapt method and language to developmental age[/checklistInput] [checklistInput type="scale"]Able to secure environment for safety according to developmental age[/checklistInput] [checklistInput type="scale"]Computerized Charting[/checklistInput] [checklistInput type="scale"]Standard Precautions/Infection Control[/checklistInput] [checklistInput type="scale"]Hand Cleaning Guidelines[/checklistInput] [checklistInput type="scale"]Patient Confidentiality & HIPAA[/checklistInput] [checklistInput type="scale"]Patient Safety Goals[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Basic Skills"] [checklistInput type="scale"]Double Bag Insolation Technique[/checklistInput] [checklistInput type="scale"]Shave & Prep. Surgical Scrub[/checklistInput] [checklistInput type="scale"]Standing Scale Weights[/checklistInput] [checklistInput type="scale"]Bed Scale Weights[/checklistInput] [checklistInput type="scale"]Linen Change: Occupied, Unoccupied[/checklistInput] [checklistInput type="scale"]Monitor & Document & Output (I & O)[/checklistInput] [checklistInput type="scale"]Special Diets: Clear liquid, Soft, NPO[/checklistInput] [checklistInput type="scale"]Set-Up/Pass Meal TRays, Juice Water[/checklistInput] [checklistInput type="scale"]Foley Care & Positioning[/checklistInput] [checklistInput type="scale"]Feeding Patients[/checklistInput] [checklistInput type="scale"]Partial/Complete Bed Bath[/checklistInput] [checklistInput type="scale"]Shower Sitz Bath[/checklistInput] [checklistInput type="scale"]Oral Care[/checklistInput] [checklistInput type="scale"]Peri-Scare[/checklistInput] [checklistInput type="scale"]Enemas[/checklistInput] [checklistInput type="scale"]Rectal Tubes[/checklistInput] [checklistInput type="scale"]D/C Foley Catheters[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Emptying & Recording Output"] [checklistInput type="scale"]N/G Tubes[/checklistInput] [checklistInput type="scale"]Hemovacs[/checklistInput] [checklistInput type="scale"]Jackson-Pratt[/checklistInput] [checklistInput type="scale"]T-tubes[/checklistInput] [checklistInput type="scale"]Foley Catheters[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Collecting Specimens"] [checklistInput type="scale"]Urine, Stool[/checklistInput] [checklistInput type="scale"]Sputum[/checklistInput] [checklistInput type="scale"]Urine: sugar, Acetone, & Specific Gravity[/checklistInput] [checklistInput type="scale"]Restraint Use, Safety, Requirements[/checklistInput] [checklistInput type="scale"]Bedside Glucose Monitoring[/checklistInput] [checklistInput type="scale"]Recognizing & Reporting Emergencies[/checklistInput] [checklistInput type="scale"]Testing Stool For Occult Blood[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Additional Skills"] [checklistInput type="scale"]Ambulate, Resposition, & Turn Patients[/checklistInput] [checklistInput type="scale"]Instruct Patients to Cough & Deep Breath[/checklistInput] [checklistInput type="scale"]Use of Incentive Spirometer[/checklistInput] [checklistInput type="scale"]Instruct & Assist Patients With Leg Exercises[/checklistInput] [checklistInput type="scale"]Put on/Taking OFF TED HOUSE/AVE Wraps[/checklistInput] [checklistInput type="scale"]Use of Assistive Devices: Hoyer Lift[/checklistInput] [checklistInput type="scale"]Decubitus Care[/checklistInput] [checklistInput type="scale"]Range of Motion (ROM) Exercises[/checklistInput] [checklistInput type="scale"]Ice packsK-Pads[/checklistInput] [checklistInput type="scale"]CPM[/checklistInput] [checklistInput type="scale"]Setting up of Post-Op/Admission Rooms[/checklistInput] [checklistInput type="scale"]Answering Call Lights[/checklistInput] [checklistInput type="scale"]Documentation of Care on Checklist Format[/checklistInput] [checklistInput type="scale"]Application of Eggcrate/Geomat[/checklistInput] [checklistInput type="scale"]Assist with Admission, Discharge, Transfer of Patients[/checklistInput] [checklistInput type="scale"]Stocking/Ordering Supplies for Unit, Kitchen[/checklistInput] [checklistInput type="scale"]Putting Patient Charts Together[/checklistInput] [checklistInput type="scale"]Communicating with Other Staff Members About Patient Condition or Complaints[/checklistInput] [checklistInput type="scale"]Post-Mortem care[/checklistInput] [checklistInput type="scale"]Restraint Safety and Guidelines[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Obtaining and Charting Vital Signs"] [checklistInput type="scale"]Blood Pressure[/checklistInput] [checklistInput type="scale"]Pulse Rate, Apical[/checklistInput] [checklistInput type="scale"]Pulse Rate, Radial[/checklistInput] [checklistInput type="scale"]Respiratory Rate[/checklistInput] [checklistInput type="scale"]Temperature, Axillary[/checklistInput] [checklistInput type="scale"]Temperature, Oral[/checklistInput] [checklistInput type="scale"]Temperature, Rectal[/checklistInput] [checklistInput type="scale"]Temperature, Tympanic Digital[/checklistInput] [checklistInput type="scale"]Notifying Staff of Abnormal Results[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Certifications"] [checklistInput type="text"]CPR[/checklistInput] [checklistInput type="text"]Other[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]