Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below)
Recruiter TEEMA email
Full Name
Email
Phone number
Are you a LPN or RN?
Total years of LPN/RN experience
Date
Documentation/Notes
0
1
2
3
4
Vital Signs – BP, TPR, Height, Weight
Intake & Output monitoring
Activities of Daily Living (ADLs)
Admission of Client
Medications: Oral, IM, SQ, PR, Topical
Body Systems Review (Head to Toe Assessment)
Bathing assistance
Oral Hygiene; Denture Care
Nail and Skin Care
Backrubs/back care
Use of Bedpan/Urinal
Bowel Regimen
Client Care Plans (Revise & Update)
Client Safety Standards/Precautions
Infection Control Precautions
Handwashing
Compresses: warm/cold
CPR
Applying/Removing TEDS stockings
Prosthetic/Assistive Devices
Restraints – Apply/Monitor
Reporting changes in client’s condition
Intravenous therapy
Colostomy Care & Irrigation
Wound Care
Discharge of Client
Pain Assessment
Traction
Supervision of LNA, PCSP
Repositioning/Transferring
Assessing Educational Needs
Teaching Client, Staff, Family, Caregivers
Coordinating Care with Team
Communicating with Physician/Provider
Documenting Orders Appropriately
Drug Calculations
Handling Emergent Situations
Reporting concerns to team/supervisor
Use of Walker/Canes
Use of Hoyer Lift
Crutch walking
Use of manual wheelchair
Use of electric wheelchair
Special Diet Restrictions (Diabetic, Low Salt, Fluid Restriction, etc.)
Making occupied bed
Basic Medical Asepsis
Oxygen (cannula, mask, etc)
Pulse Oximetry
Range of Motion Exercises
Assist with Ambulation
Dressing changes
Advance Directives
Postmortem Care
Cast Care
GT/NG tubes
Ostomy Care
Catheterization – straight/foley
Incentive Spirometry
Specimen Collection
Phlebotomy
Urine Dipstick
Fingerstick Blood Glucose Monitoring
Suctioning
Tracheostomy Care
Transfer/Transport Clients
Alzheimer’s/Dementia
Stroke
Asthma/COPD/Respiratory Illness
Head Injuries
Amputation
Diabetes
Pacemaker
Spinal Cord Injury
Wounds/Drains
Tracheostomy
CHF/Cardiac Disease
Renal Disease
Hip/Knee Replacements
AIDS/Immunosuppression
Cancer
Burns
Recent Surgery
Mental Illness
Multiple Trauma
Terminal Illness
Newborn (birth – 30 days)
Infant (31 days – 1 year)
Toddler (1 – 3 years)
Preschooler (3 – 5 years)
School Age (5 – 12 years)
Adolescents (12 – 18 years)
Young Adults (18-39 years)
Middle Adults (39 – 64 years)
Older Adults (64+ years)
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I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.
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