CNA/Home Health Aide Skills Assessment Checklist

First Name*

Last Name*

Date*

Date

Total years of CNA/HHA*

Medication *

	No Experience	Need Instruction	Need Refreshing	Competent
Medication Reminder
Reporting Med side Effects

Assist with Ambulation:*

Assist with Toileting:*

Bathing:*

Bedbound Care:*

Bowel Movements:*

	No Experience	Need Instruction	Need Refreshing	Competent
Constipation
Diarrhea
Cleaning
Cooking
Reporting Change of Condition

Foley Catheter Care:*

	No Experience	Need Instruction	Need Refreshing	Competent
Emptying Bag***
Diarrhea
Cleaning
Cooking
Reporting Change of Condition

Foley Catheter Care:*

	No Experience	Need Instruction	Need Refreshing	Competent
Emptying Bag***
Changing Leg Bag

Gloves:*

Oral Hygiene:*

Ostomy:*

	No Experience	Need Instruction	Need Refreshing	Competent
Emptying Bag
Changing Bag

Oxygen/How to apply:*

	No Experience	Need Instruction	Need Refreshing	Competent
Emptying Bag
Safe issues- No smoking **
No open flames or candles, 02 signage visible at the main do
02 Tanks place in appropriate canister/ holder

Personal Care:*

Transfers:*

Wheelchair Operation:*

	No Experience	Need Instruction	Need Refreshing	Competent
How to lock chair
How to remove leg rest

Patient:*

	No Experience	Need Instruction	Need Refreshing	Competent
Working with children
Working with Dementia & Alzheimer Patient

Operate DME:*

Set-up tray Feeding:*

Signature*

Date