CNA Orientation Competency Checklist

Step 1 of 31

Employee Information

Employee Name(Required)

First Middle Last

Unit(s)(Required)

Harbor

Hearthside

Wellsprings

Horizons

Introduction

Please complete the following checklist with your preceptor's and return to Staff Development Coordinator. This will be part of your 6 month employee evaluation process. Failure to complete this may affect the outcome of the introductory period evaluation.

*THIS IS A MANDATORY EMPLOYEE PROCESS

Abuse/Unusual Occurrence

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Verbalizes understanding of Policy and Procedure – HR Orientation(Required)

Satisfactory

Unsatisfactory

B. Reporting Procedure – HR and Unit(Required)

Satisfactory

Unsatisfactory

Daily Routine:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. How to clock in and out(Required)

Satisfactory

Unsatisfactory

B. Introduction to other staff members on unit(Required)

Satisfactory

Unsatisfactory

C. Introduction to Residents on unit(Required)

Satisfactory

Unsatisfactory

D. Procedure and location for purchasing meal tickets(Required)

Satisfactory

Unsatisfactory

E. Verbalizes understanding of break locations and procedure(Required)

Satisfactory

Unsatisfactory

F. Identifies and verbalizes understanding of the following: location of schedule, C.N.A assignment sheet, Fall prevention sheet, activity calendar for residents, beauty shop list, daily scheduled outside appointment schedule(Required)

Satisfactory

Unsatisfactory

G. Verbalizes understanding of procedure to request time off(Required)

Satisfactory

Unsatisfactory

H. Verbalizes understanding of procedure for reporting and absence(Required)

Satisfactory

Unsatisfactory

I. Verbalizes understanding of procedure to use a punch correction form(Required)

Satisfactory

Unsatisfactory

J. Demonstrates knowledge of charging out resident supplies(Required)

Satisfactory

Unsatisfactory

K. Demonstrates knowledge of where to find appropriate linens and incontinent supplies(Required)

Satisfactory

Unsatisfactory

L. Demonstrates knowledge of proper procedure and location for discarding soiled linens.(Required)

Satisfactory

Unsatisfactory

M. Demonstrates appropriate Shift Rounds – Job Responsibilities(Required)

Satisfactory

Unsatisfactory

N. Appropriately dresses residents to time of day, season, to include bra, slip, hose, socks, and shoes.(Required)

Satisfactory

Unsatisfactory

O. Ensures resident has glasses, dentures, and hearing aids on and that appliances are clean and in good working order.(Required)

Satisfactory

Unsatisfactory

P. Demonstrates proper showering of resident.(Required)

Satisfactory

Unsatisfactory

Q. Demonstrates proper nail care of resident(Required)

Satisfactory

Unsatisfactory

R. Verbalizes understanding of the Equipment cleaning schedule(Required)

Satisfactory

Unsatisfactory

S. Verbalizes understanding of Dress Code and Proper Attire(Required)

Satisfactory

Unsatisfactory

T. Acknowledges understanding of the Resident Care Conference(Required)

Satisfactory

Unsatisfactory

U. Demonstrates proper procedure for filling up Oxygen tanks(Required)

Satisfactory

Unsatisfactory

Care Plans

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Follows the resident’s care plans implements person center care and cultural competencies (including ADL, fall, restorative care plans).(Required)

Satisfactory

Unsatisfactory

B. Promotes resident independence with ADL’s.(Required)

Satisfactory

Unsatisfactory

Code Procedure:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Emergency Cart(Required)

Satisfactory

Unsatisfactory

1. Location and survey of supplies available(Required)

Satisfactory

Unsatisfactory

2. Procedure for setting up the E-Cylinder(Required)

Satisfactory

Unsatisfactory

Communication

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Effectively communicates with both resident and other members of the Health Care Team.(Required)

Satisfactory

Unsatisfactory

Condition Change/Items to Report to Nurse

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Reporting procedure(Required)

Satisfactory

Unsatisfactory

B. Change in mental state(Required)

Satisfactory

Unsatisfactory

C. Aggressive behaviors/verbalization(Required)

Satisfactory

Unsatisfactory

E. Alteration in skin integrity(Required)

Satisfactory

Unsatisfactory

F. Falls-DO NOT MOVE THE RESIDENT.(Required)

Satisfactory

Unsatisfactory

G. Failure to meet shift fluid goal(Required)

Satisfactory

Unsatisfactory

H. Difficulty in swallowing, choking(Required)

Satisfactory

Unsatisfactory

I. Elimination (including but not limited to the following: burning with urination, changes in the color of urine or bowel movement, low urine output, constipation)(Required)

Satisfactory

Unsatisfactory

Dietary- Verbalizes and/or Demonstrates knowledge of the following:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Diet Requisition (also as resident requests)(Required)

Satisfactory

Unsatisfactory

B. Dining Room Areas(Required)

Satisfactory

Unsatisfactory

C. Tray delivery and pick up times on unit(Required)

Satisfactory

Unsatisfactory

D. Snack Times(Required)

Satisfactory

Unsatisfactory

Disaster Procedures:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Able to locate Disaster Manuals, Disaster cart in facility(Required)

Satisfactory

Unsatisfactory

B. Demonstrates Procedure for Fire Drill, and use of Fire panel(Required)

Satisfactory

Unsatisfactory

C. Demonstrates Procedure for Fire Extinguisher(Required)

Satisfactory

Unsatisfactory

Elopement (wandering):

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Policy and Procedure – HR Orientation(Required)

Satisfactory

Unsatisfactory

Equipment – Demonstrates knowledge and proper use of the following:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Restrictive Lifting Policy(Required)

Satisfactory

Unsatisfactory

B. Sit to Stand Up Lift(Required)

Satisfactory

Unsatisfactory

C. Full Body Lift(Required)

Satisfactory

Unsatisfactory

D. Volaro Lift(Required)

Satisfactory

Unsatisfactory

E. Specialty Mattresses / Bed(Required)

Satisfactory

Unsatisfactory

F. Whirlpool(Required)

Satisfactory

Unsatisfactory

G. Electric bed(Required)

Satisfactory

Unsatisfactory

H. Trapeze(Required)

Satisfactory

Unsatisfactory

I. Bed cradles/foot boards(Required)

Satisfactory

Unsatisfactory

J. Stand on and Wheelchair scales(Required)

Satisfactory

Unsatisfactory

K. Oxygen tanks(Required)

Satisfactory

Unsatisfactory

L. Demonstrates proper use of Gait belt(Required)

Satisfactory

Unsatisfactory

M. Call light system and the Emergency Call Light System(Required)

Satisfactory

Unsatisfactory

Hazard Communication

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Location of Hazard Policy and Procedures(Required)

Satisfactory

Unsatisfactory

B. Use and Location of M.S.D.S Sheets(Required)

Satisfactory

Unsatisfactory

HIPAA & Confidentiality

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Demonstrates HIPAA in regards to PHI and EPHI.- in Relias(Required)

Satisfactory

Unsatisfactory

Hospice

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Verbalizes understanding of Policy and Procedure(Required)

Satisfactory

Unsatisfactory

Infection Control/Medical Asepsis and Cleaning

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Heritage Center’s Bloodborne Pathogen Policy & Procedure- Relias(Required)

Satisfactory

Unsatisfactory

-Procedure for handing exposure to body/body fluids- in Relias(Required)

Satisfactory

Unsatisfactory

B. Demonstrates & disinfects shower chairs & shower stall between residents(Required)

Satisfactory

Unsatisfactory

C. Demonstrates knowledge of procedure for disinfecting and proper storage of the following items: combs, brushes, wheelchairs, canes, over bed tables per unit assignment(Required)

Satisfactory

Unsatisfactory

D. Demonstrates and discards dirty linen using proper technique(Required)

Satisfactory

Unsatisfactory

E. Practices appropriate Respiratory Hygiene/Cough Etiquette to control respiratory secretions.(Required)

Satisfactory

Unsatisfactory

F. Procedure for isolation precautions and equipment location(Required)

Satisfactory

Unsatisfactory

G. Demonstrates proper handwashing technique(Required)

Satisfactory

Unsatisfactory

Incident Reporting:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

V. Verbalizes understanding of Policy and Procedures for Reporting(Required)

Satisfactory

Unsatisfactory

W. Verbalizes understanding for reporting Resident Incidents(Required)

Satisfactory

Unsatisfactory

X. Verbalizes understanding for reporting Employee Incidents(Required)

Satisfactory

Unsatisfactory

Y. Verbalizes understanding for reporting Visitor Incidents(Required)

Satisfactory

Unsatisfactory

Minimal Data Sheet (MDS)

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Verbalizes understanding of what M.D.S. is & impact of charting/how effects the outcome(Required)

Satisfactory

Unsatisfactory

Nutrition and Hydration:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Provides direct conversation with resident during meals(Required)

Satisfactory

Unsatisfactory

B. Verbalizes understanding employees are not to eat or drink while feeding residents and that they are to never take resident food.(Required)

Satisfactory

Unsatisfactory

C. Ask permission to apply a clothing protector(Required)

Satisfactory

Unsatisfactory

D. Demonstrates removing clothing protector per meals and washes resident’s hands and face as needed.(Required)

Satisfactory

Unsatisfactory

E. Documents meal consumption % in POC(Required)

Satisfactory

Unsatisfactory

F. Passes fresh water per policy and records water consumption.(Required)

Satisfactory

Unsatisfactory

G. Passes snacks/nutritional supplements at assigned times & documents % in POC.(Required)

Satisfactory

Unsatisfactory

On Line Inservice Training

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Demonstrates Correct Procedures for accessing Relias for continuing employee education and training(Required)

Satisfactory

Unsatisfactory

Pain Control

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Can explain the use of a pain scale & can assist resident in using it to describe pain level.(Required)

Satisfactory

Unsatisfactory

Point of Care (POC) (Documentation):

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Demonstrates Correct Procedure for logging in to POC(Required)

Satisfactory

Unsatisfactory

B. Demonstrates how to make assignment list in POC(Required)

Satisfactory

Unsatisfactory

C. Demonstrates Daily Documentation for POC(Required)

Satisfactory

Unsatisfactory

1. Weights(Required)

Satisfactory

Unsatisfactory

2. Intake and Output; % of meals(Required)

Satisfactory

Unsatisfactory

Vital Signs(Required)

Satisfactory

Unsatisfactory

D. Restorative Care Charting(Required)

Satisfactory

Unsatisfactory

E. Demonstrates how to access the Kardex(Required)

Satisfactory

Unsatisfactory

F. Demonstrates proper procedure and use of secure care conversations(Required)

Satisfactory

Unsatisfactory

Performance Improvement

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. QAPI- verbalizes understanding of definition and purpose(Required)

Satisfactory

Unsatisfactory

Resident Rights

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Policy and Procedure for Residents Rights – HR Orientation(Required)

Satisfactory

Unsatisfactory

B. Provides care that maintains dignity and privacy- Unit Orientation(Required)

Satisfactory

Unsatisfactory

Restorative Care: Demonstrates and/or Verbalizes understanding of following:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Definition & Categories(Required)

Satisfactory

Unsatisfactory

B. Demonstrates knowledge/skills necessary for implementing procedures for the Restorative Nursing Program.(Required)

Satisfactory

Unsatisfactory

C. Utilizes anti-contractures devices(Required)

Satisfactory

Unsatisfactory

Handrolls/palm cones-removes daily, washes, and dries skin well(Required)

Satisfactory

Unsatisfactory

Proper storage of anti-contractures devices(Required)

Satisfactory

Unsatisfactory

Safety

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Demonstrates knowledge of:(Required)

Satisfactory

Unsatisfactory

-Utilizes safety devices correctly for fall prevention as indicated on Kardex (non- skid rugs/mats, positioning devices)(Required)

Satisfactory

Unsatisfactory

-Proper storage of safety devices. No items stored on floor.(Required)

Satisfactory

Unsatisfactory

B. Demonstrates and verbalizes understanding of use of security devices: (including but not limited to secure care bracelets)(Required)

Satisfactory

Unsatisfactory

Skin Breakdown Prevention and Pressure Ulcer Staging Guidelines:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Verbalizes understanding of basic pressure ulcer staging guidelines(Required)

Satisfactory

Unsatisfactory

B. Demonstrates and utilizes protective devices to help prevent skin breakdown per C.N.A. assignment sheet. (heel, elbows, float heels)(Required)

Satisfactory

Unsatisfactory

C. Demonstrates use of pad between knees-no skin contact(Required)

Satisfactory

Unsatisfactory

D. Demonstrates appropriate checks of skin during baths for signs of skin breakdown(Required)

Satisfactory

Unsatisfactory

E. Demonstrates and provides proper support of extremities in bed and chair to prevent skin tears, pressure areas.(Required)

Satisfactory

Unsatisfactory

Suicide

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. Policy and Procedure – (Reviewed by Employee)(Required)

Satisfactory

Unsatisfactory

Additional Competencies Based Upon Job descriptions/Unit Responsibilities

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

A. General Job Duties- shift responsibilities; verbalized understanding of duties(Required)

Satisfactory

Unsatisfactory

Comments

Comment

Procedural Competency Checklist Acknowledgement:

Acknowledgement(Required)

I acknowledged that I have performed the tasks as checked above and that I have a clear understanding of each item listed within the document. I also acknowledge that this training has adequately prepared me with the knowledge and tools to perform the job duties of a CNA at The Heritage Center.(Required)

C.N.A. Signature(Required)

Date(Required)

MM slash DD slash YYYY

Name

This field is for validation purposes and should be left unchanged.