CNA Skills Checklist
0 = Never done, less than 3 months experience or experience not within the last year
1 = 3 months or greater current experience
2 = 1 year or greater current experience
Your Name *
Last name, First name
Your answer
General - ADL's -Bed Bath *
Required
A.M. Care *
Required
Sitz Bath *
Required
Foley Catheter Care *
Required
Vital Signs *
Required
Air Mattress *
Required
Prevent. and Treat. of Decubitus Ulcers *
Required
Body Positioning *
Required
Patient Transfer Techniques *
Required
Ice Collar-Application *
Required
ACCU Checks *
Required
Specimen Collection: Sputum *
Required
Specimen Collection: Clean Catch Urine *
Required
Specimen Collection: Stool *
Required
Aqua K-Pads/Heat Packs *
Required
Height/Weight *
Required
I & O *
Required
Dressing Changes: Sterile *
Required
Dressing Changes: Clean *
Required
Douche *
Required
Enema *
Required
X-Ray Preps *
Required
Tube Feedings: N/G Tube *
Required
Tube Feedings: Peg Tube *
Required
Clinitest/ Acetest *
Required
Charting *
Required
Hoyer Lift *
Required
Hypo/ Hyperthermia Blankets *
Required
Isolation Techniques *
Required
Universal Precautions *
Required
Oxygen *
Required
Post-Mortem Care *
Required
Nasopharyngeal Suctioning *
Required
Range of Motion: Active *
Required
Range of Motion: Passive *
Required
Equipment: Crutches *
Required
Equipment: Walker *
Required
Equipment: Cane *
Required
Equipment: Wheelchair *
Required
Wound Care *
Required
I certify that this is my skills checklist. *
Please type your full name in lieu of a signature.
Your answer
Date
Please
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms