Home Health Aide Skills Checklist
This form assist to identify home health aide training and orientation.
Aide Name
*
Name
Last Name
Vital Signs
Rows
Unfamiliar
Familiar
Practiced
Expert
Temperature - oral
Temperature - rectal
Pulse - Apical
Blood Pressure
Containing respirations
Personal Care
Rows
Unfamiliar
Familiar
Practiced
Expert
Bed Bath
Sponge Bath
Tub Bath
Shower
Nail and Skin Care
Oral Hygiene
Swab
Denture Care
Shave
Assist with Dressing
Elimination
Rows
Unfamiliar
Familiar
Practiced
Expert
Use of Bed Pan
Bowel Program
Use of Bedside Commode
Measure Urine Output
Empty Foley Catheter Drainage Bag
Safe Transfer Technique
Rows
Unfamiliar
Familiar
Practiced
Expert
Range of Motion
Repositioning in Bed
Walker
Hoyer Lift
Assist with Ambulation
Care Experience
Rows
Unfamiliar
Familiar
Practiced
Expert
Care of Alzheimer Client
Care of Client withRespiratory Difficulties
Care of Client with Stroke
Care of Client with Head Injury
Care of the Paraplegic or Quadriplegic Client
Diabetic Care
Care of the Amputee Client
Care of Bed Bound Client
Housekeeping Duties
Rows
Unfamiliar
Familiar
Practiced
Expert
Washing Clothes
Folding Clothes
Dishes
Mop Floors
Dusting
Grocery Shopping / Errands
Assist with Feeding
Special Diet Instructions
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Evaluating Nurse
RN OR LPN?
*
Please Select
RN
LPN
Name
*
First Name
Last Name
Notes:
*
Add notes in regard to the Skills Check here.
Signature
*
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: