CNA Checklist


Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Total Stars:

Obtained Stars:

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  Patient Rights         Rating Stars (Click) 1 2 3 4
  Communicates and obtains information while respecting the rights and privacy and confidentiality of information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)  
  Involves the patient and family and respects their role in determining the nature of care to be provided  
  including Advance Directives  
  Complies with nursing staff responsibility included in the hospital policy related to Organ Donation  
  Meets patient and families needs regarding communication- including interpreter services  
  Provides accurate information to patient and families in a timely manner  
  Vital Signs and Weights         Rating Stars (Click) 1 2 3 4
  Placing and Removing Bed Pan  
  Clamping Catheter  
  Emptying Foley Bag  
  Placing Condom Catheter  
  Emptying and Replacing Ostomy Bag (Established Ostomy)  
  Use of Electronic VS equipment         Rating Stars (Click) 1 2 3 4
  Automatic BP machine (Dynamap)  
  Electronic Thermometer  
  Applying Oximeter  
  Scale Use         Rating Stars (Click) 1 2 3 4
  Standing  
  Chair  
  Bed  
  GI /GU         Rating Stars (Click) 1 2 3 4
  Report Abnormal Findings  
  Bowel Function  
  Bladder Function  
  Administering Enemas         Rating Stars (Click) 1 2 3 4
  Tap Water  
  Fleets  
  Return Flow  
  Nutrition         Rating Stars (Click) 1 2 3 4
  Estimating Intake  
  Setting up for Meals  
  Feeding Patients  
  Aspiration Precautions  
  Nourishments  
  Counting Calories  
  Fluid Restriction  
  NPO  
  Specimens         Rating Stars (Click) 1 2 3 4
  Collecting Stool  
  Collecting Sputum  
  Labeling Specimens and Preparing for Transport  
  Collecting Urine         Rating Stars (Click) 1 2 3 4
  Clean Catch  
  24 Hour  
  Hygiene /Skin         Rating Stars (Click) 1 2 3 4
  Risk Factorsfor Skin Breakdown  
  Observing Pressure Points for Redness or Breakdown  
  Bathing /Daisy Hygiene         Rating Stars (Click) 1 2 3 4
  Bathing (Shower /Tub /Arjo)-Oral Care  
  Including Patients who are NPO  
  Comatose  
  Patients with  
  Pen Care  
  Foot Care for Patients with Impaired Circulation or Sensation  
  Incontinence Care  
  Shaving and Precautions  
  Reducing Pressure and Friction  
  Use of Pressure and Friction Reduction Devices         Rating Stars (Click) 1 2 3 4
  Special Beds/Mattresses  
  Heels and Elbow Protection  
  Foot Cradles  
  Use of Shower Chair  
  Use of Bath/Shower Boat  
  Infection Control         Rating Stars (Click) 1 2 3 4
  Reverse Isolation  
  Body Substance isolation  
  TB Precautions  
  MRSA Precautions  
  Hand Washing  
  Infectious/Hazardous Waste Disposal  
  Supply/Equipment Disposal  
  Use of Disposable Therrnomete  
  Use of CPR Mask/Bag  
  Proper use of Specific Barrier, Methods         Rating Stars (Click) 1 2 3 4
  Gloves  
  Gown  
  Mask / Goggles  
  Safety and Activity         Rating Stars (Click) 1 2 3 4
  Determining Patient ID  
  Identifying Safety Hazards  
  Determining Need for Additional Help  
  Assessing Safety and ADL Needs  
  Recognizing Abuse: Substance  
  Physical  
  Emotional  
  etc  
  MaintainingClean  
  Orderly Work Area  
  Disposing of Sharps  
  Handling Hazardous Materials  
  Proper Body Mechanics  
  ROM Exercises  
  Transferring to Bed  
  WC  
  Commode  
  etc  
  Turning and Positioning  
  Patient Safety Module  
  Reporting Broken Equipment  
  Responding to Safety Hazards  
  Use of HoyerLift (Dextra /Maxi)  
  Bed Operation  
  Use of Wheel Locks  
  Use of Alarms- Bed-Patient-Unit  
  Use of CaIl Light  
  Documenting Use of Restraints  
  Use of Transfer Belt  
  Use of Gait Belt for Ambulation  
  Use of Seizure Pads  
  Application of Restraints:         Rating Stars (Click) 1 2 3 4
  Belt Including Seat Belt  
  Wrist/Ankle  
  Vest  
  New Admissions and Transfers:         Rating Stars (Click) 1 2 3 4
  Inventory andDispositionof Belongings-Useof Checklist  
  Room Orientation-Call Bell  
  Post-op Patients:         Rating Stars (Click) 1 2 3 4
  Transferring into Bed  
  Call Bell  
  Assist with Turns  
  ROM Exercises  
  Maintaining 02 Therapy:         Rating Stars (Click) 1 2 3 4
  Replacing Mask or Nasal Caunula if Needed  
  Notifying Nurse of Problems  
  Basic Comfort Measures  
  Preparation For and Transfer to SNF:         Rating Stars (Click) 1 2 3 4
  Early Bath  
  Preparing Belongings  
  Preparingfor and Explaining Routinesto Patient  
  Post Mortem Care  
  Use ofIncentive Spirometer  
  Removing /Replacing:         Rating Stars (Click) 1 2 3 4
  Antiembolic Stockings  
  Sequential Stockings  
  Communication         Rating Stars (Click) 1 2 3 4
  Using Appropriate Abbreviations  
  Identifying UnusuaI Patient Incidents that Require Reporting  
  Selecting and Using Forms Appropriately  
  Using Alternate Communication Tools /Devices  
  Communicating to RN:         Rating Stars (Click) 1 2 3 4
  Changes in Patient Condition  
  Patient Needs-Complaints and Concerns  
  Unusual Incidents  
  Recording and Reporting:         Rating Stars (Click) 1 2 3 4
  Vital Signs  
  Bathing /Hygiene  
  Turning and Repositioning  
  Ambulation and Activity  
  Diet intake-Calorie Count  
  Bowel Movements  
  1 & 0:         Rating Stars (Click) 1 2 3 4
  Shift Volumes and Totals  
  Marking and /or Measuring Amount of Urine  
  Gastric Fluid  
  NG Drainage  
  Emesis  
  Diarrhea  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  Infant (Birth - 1 year)  
  Preschooler (ages 2-5 years)  
  Childhood (ages 6-12 years)  
  Adolescents (ages 13-21 years)  
  oung Adults (ages 22-39 years)  
  Older Adults (ages 65-79 years)  
  Adults (ages 40-64 years)  
  Elderly (ages 80+ years)  
  Unit Activity         Rating Stars (Click) 1 2 3 4
  Identifying Unusual Incidents on the Unit that Require Reporting  
  Locating and Using Appropriate Reference Materials: Hospital0- Patient Care and  
  Charging for Patient Care Items  
  Completing Risk Management Reports as Needed  
  Obtaining Needed Supplies and Equipment  
  Reporting and Following up on Faulty Equipment and Supplies  
  Using Telephone System