CNA Skills Assessment
Name
*
First Name
Last Name
Email
*
example@example.com
Date
*
-
Month
-
Day
Year
Date
AGE OF PATIENTS CARED FOR
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler/Preschool (13 months to 5 years)
School Age Child/adolescent (6 years to 18 years)
Young Adults/Middle Adult (19 years to 64 years)
Older Adults/Elderly (65+ years)
GENERAL SKILLS
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not Applicable
Care of Patient in Restraints
Documentation of ADLs, I&O
Universal Precautions
Measuring and Documenting Intake and Output
Standing Scale Patient Weight
Bed Scale Patient Weight
Charting
Bed Making Occupied
Bed Making Unoccupied
Code Cart
Point of Care Blood Glucose Monitoring
Bed Rails (Putting Up, Down, How to Use)
Bed Alarm
Vital Signs
Hand Hygiene
Coughing and Deep Breathing
Dietary Needs
Urine Specimen Collection-Routine
Urine Specimen Collection-Clean Catch
Urine Specimen Collection-12 and 24 Hour
Stool Specimen Collection
Reporting Change in Patient Condition
Dismissal of Patient
Knowledge of current Joint Commission National Patient Safety Goals
Knowledge/familiarity with HCAHPS scores
Activities of Daily Living
Assisting With Ambulation
Assisting With Toileting
Bathing of Patient (Shower, Bed Bath)
Perineal Care
Back Care
Positioning of Patient
Range of Motion Exercises
Foley Care and Measuring of Output
Oral Hygiene
Denture Care
Skin Care
Electronic Documentation
Allscripts
Care360
Cerner
eCLinicalWorks
EPIC
MACLAB
McKesson
Meditech
PACS
Soarian
Other
WOUND/SKIN CARE
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not Applicable
Dressing Changes
Pressure Relief Mattresses
Decubitus Ulcers
Leg Ulcers
Hemovacs
Jackson-Pratt Drains
Penrose Drains
Surgical Wound Irrigations & Dressings
INFECTIOUS DISEASE
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not Applicable
HIV
MRSA
CRE
VRE
C. Difficile
Hepatitis
Influenza
Isolation Precautions
Shingles
Scabies
Please list any additional skills not listed above.
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