Gees Home Caring Agency, LLC
Competency Evaluation Assessment: CNAs & PCAs
Employee Name
First Name
Last Name
Skills Check (type response in each column)
Rows
Competent
Needs Improvemets
Date
Initials
Tetest Date/Initials
Principles, goals and boundary issues related to personal support services
Observation, Reporting documentation of Patient Status and care of services provided
Basic Infection Control Procedures
Hand Washing
Gloves
Disposing of Hazardous Materials
Appropriate and safe techniques in personal hygiene and grooming
Bed Bath
Tub and Shower Safety
Mouth Care
Haur Care
Nail Care
General Skin Care
Shaving
Shampoo - sink, shower, tub
*Patient Positioning
* Range of Motion
Make Bed
Urinal
Bedpan
Commode
Care of Incontinent Patient
Foley Catheter Care
Wheelchair
Assist with Ambulation
Safe Transfer Techniques
Hoyer Lift
Body Mechanics
Body Systems and Functions
Staff Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: