-Apply Now: CNA

Skills Assessment - CNA

The following checklist will be used to match your skills and interests with available assignments. Please enter your information, and we will store this information with your application/profile. Please indicate your level of proficiency by marking the appropriate number.

First Name:

Middle Initial:

Last Name:

SSN:

- -

E-mail Address:

Home Phone:

- -

Work Phone:

- -

Cell Phone:

- -

City:

State:

0. Theory, no practice 1. Limited 2. Confident 3. Very Confident

Experience:

Provide AM care

0 1 2 3

Provide PM care

0 1 2 3

Assist patient with ambulation

0 1 2 3

Provide back and skin care

0 1 2 3

Give a bed bath

0 1 2 3

Care for bedsores

0 1 2 3

Care for Foley catheter

0 1 2 3

Provide colostomy care

0 1 2 3

Apply cold compresses

0 1 2 3

Change non-sterile dressings

0 1 2 3

Administer enema

0 1 2 3

Assist with exercise/ROM

0 1 2 3

Provide hair care

0 1 2 3

Use correct hand washing technique

0 1 2 3

Calculate and record intake and output

0 1 2 3

Use correct isolation technique

0 1 2 3

Complete menu with patient

0 1 2 3

Provide oral hygiene

0 1 2 3

Provide perineal care

0 1 2 3

Provide post-mortem care

0 1 2 3

Shave patient

0 1 2 3

Transfer/transport patient

0 1 2 3

Take vital signs: TPR & BP

0 1 2 3

Apply restraints

0 1 2 3

Universal precautions

0 1 2 3

Feed patient

0 1 2 3

Dispose of sharps

0 1 2 3

Use of correct side rail position

0 1 2 3

Specimen collection
(urine, stool, sputum)

0 1 2 3

Follow fluid restrictions

0 1 2 3

Use of special mattresses

0 1 2 3

Provide ostomy care

0 1 2 3

Administer sitz bath

0 1 2 3

Weigh patient/use of scale

0 1 2 3

Apply TED hose

0 1 2 3

Use of aqua-K pads

0 1 2 3

Complete admission paperwork

0 1 2 3

Discharge a patient

0 1 2 3

Stock supplies

0 1 2 3

Clean equipment

0 1 2 3

Answer phone

0 1 2 3

Assist with care of the patient with alcoholism

0 1 2 3

Assist with care of the patient with amputation

0 1 2 3

Assist with care of the patient with arthritis

0 1 2 3

Assist with care of the blind patient

0 1 2 3

Assist with care of the patient with cancer

0 1 2 3

Assist with care of the patient with cataracts

0 1 2 3

Assist with care of the comatose patient

0 1 2 3

Assist with care of the confused/disoriented patient

0 1 2 3

Assist with care of the patient with convulsions

0 1 2 3

Assist with care of the deaf patient

0 1 2 3

Assist with care of the drug abuse patient

0 1 2 3

Assist with care of the patient with diabetes

0 1 2 3

Assist with care of the patient with fractures

0 1 2 3

Assist with care of the patient with a gastrotomy

0 1 2 3

Assist with care of the geriatric patient

0 1 2 3

Assist with care of the patient with dementia

0 1 2 3

Assist with care of the patient with heart condition

0 1 2 3

Assist with care of the incontinent patient

0 1 2 3

Assist with care of the infant

0 1 2 3

Assist with care of the child

0 1 2 3

Assist with care of the patient with multiple sclerosis

0 1 2 3

Assist with care of the patient with a pacemaker

0 1 2 3

Assist with care of the paraplegic patient

0 1 2 3

Assist with care of the quadriplegic patient

0 1 2 3

Assist with care of the patient with Parkinson's disease

0 1 2 3

Assist with care of the retarded patient

0 1 2 3

Assist with care of the senile patient

0 1 2 3

Assist with care of the patient in shock

0 1 2 3

Assist with care of the patient with stroke

0 1 2 3

Assist with care of the terminally ill patient

0 1 2 3