Certified Nursing Assistant (CNA)

Certified Nursing Assistant (CNA)

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1 – 2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Personal Information

Name
Name
First
Last
AGE OF PATIENTS CARED FOR
Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler/Preschool (13 months to 5 years)
School Age Child/adolescent (6 years to 18 years)
Young Adults/Middle Adult (19 years to 64 years)
Older Adults/Elderly (65+ years)

GENERAL SKILLS

Electronic Documentation

Activities of Daily Living

WOUND/SKIN-Care of Patient with:

ADDITIONAL SKILLS-Care of Patient With

INFECTIOUS DISEASE – Care of the patient with

Application Agreement

The information I have given is true and accurate to the best of my knowledge, and I hereby authorise Explore TEK. to release this Skills Checklist to staffing clients of Explore TEK. Submit this skills evaluation with your initial application. To be updated annually.