* = Required Information
A = Able to perform without any supervision
B = Perform infrequently (would require some supervision)
C = No Experience
Document Overview
A
B
C
Residential rights
A
B
C
Tray Setup
A
B
C
Residents Weights
A
B
C
Hand Washing
A
B
C
Cleansing Enema
A
B
C
Giving and Removing Bedpan/Urinal
A
B
C
Taking and Recording: BP, TEMP, WGT, P. and HR
A
B
C
Shaving
A
B
C
Bathing
A
B
C
Feeding
A
B
C
Communication with Residents
A
B
C
Follow Infection Control Procedures
A
B
C
Correct Use of Side Rails
A
B
C
Nutritional Care
A
B
C
Oral Care
A
B
C
Care of Resident with Dementia
A
B
C
Rehabilitation Program
A
B
C
Orientation to Shift Responsibilities
A
B
C
Nursing Policies and Procedures
A
B
C
Bowel and Bladder Program
A
B
C
Review of Appropriate Transfer & Lifting Procedures
A
B
C
Emergency Equipment
A
B
C
Admission Duties
A
B
C
Discharge Duties
A
B
C
Orientation to Shift Responsibilities Routine
A
B
C
Location of Fire Pull Station
A
B
C
Skin Care
A
B
C
Peri Care
A
B
C
Passive Range of Motion Competency
A
B
C
Nail Cabed Making
A
B
C
Correct Use of the Hoyre Lift
A
B
C
Taking and Recording: BP, TEMP, WGT, P. and HR
A
B
C
Bed Making: Occupied/Unoccupied
A
B
C
Measuring the Intake and Output
A
B
C
Collection: Urine, stool, Sputum Specimens
A
B
C
Assisting Residents to Ambulate
A
B
C
Assisting Residents to W/O
A
B
C
Safety Procedures
A
B
C
The information that I have given is accurate and true to the best of my knowledge. I hereby authorize Pace Medical Staffing, Inc. to release same to her client health care facilities.
Signature
*
Date
Submit