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Certified Nursing Assistant Skills Checklist

Certified Nursing Assistant Skills Checklist Please complete the CNA Skills Checklist and return to the agency Full Name (Required): _____. Social Security Number: _____. Home Phone: _____ Cell Phone: _____. Please indicate your level of experience (Circle appropriate answer using key below). A. Theory, no practice C. Performs with minimal instruction B. Performs with moderate instruction D. Performs independently A. Provides basic age appropriate physical care and comfort RN Observed measures and assistance with activities of daily living. 1. Baths .. A B C D _____. 1. A B C D _____. 2. Nail Care .. A B C D _____. 3. Oral B C D _____. 4. Routine Skin Care .. A B C D _____. 5. B C D _____. 6. Back Rubs .. A B C D _____. 7. Ambulation Assistance .. A B C D _____. 8. Oral and Nasal Care for Patients with NG Tube Feedings .. A B C D _____. 9. Routine Catheter Care for Indwelling and External A B C D _____.

Certified Nursing Assistant Skills Checklist Page 1 of 3 CNA Skills Checklist.doc © 2007 CarePlus Please complete the CNA Skills checklist and return to the agency

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