CNA Skills Checklist

Personal Information

MM slash DD slash YYYY

Proficiency Scale

1 – No Experience
2 – Need Training
3 – Able to perform with supervision
4 – Able to perform independently

Patient Rights

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

Obtaining and Recording
BP, including Orthostatic
Pulse, Radia
Temperature, Oral
Temperature, Rectal
Temperature, Axillary
Temperature, Tympanic
Weight, Pounds and Kilograms
Recognizing Cardiac Arrest
Activating Code Team
Bringing Emergency Equipment to Room
Providing Appropriate Code Support

Use of Electronic VS equipment

Automatic BP machine (Dynamap)
Electronic Thermometer
Applying Oximeter

Scale Use



Report Abnormal Findings
Bowel Function
Bladder Function

Administering Enemas

Tap Water
Return Flow

Vital Signs and Weights

Placing and Removing Bed Pan
Clamping Catheter
Emptying Foley Bag
Placing Condom Catheter
Emptying and Replacing Ostomy Bag (Established Ostomy)


Estimating Intake
Setting up for Meals
Feeding Patients
Aspiration Precautions
Counting Calories
Fluid Restriction


Collecting Stool
Collecting Sputum
Labeling Specimens and Preparing for Transport

Collecting Urine

Clean Catch
24 Hour

Hygiene /Skin

Risk Factors for Skin Breakdown
Observing Pressure Points for Redness or Breakdown

Bathing / Daisy Hygiene

Bathing (Shower / Tub / Arjo)
Oral Care, Including Patients who are NPO, Comatose
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

Special Beds/Mattresses
Heels and Elbow Protection
Foot Cradles
Use of Shower Chair
Use of Bath/Shower Boat

Infection Control

Reverse Isolation
Body Substance Isolation
TB Precautions
MRSA Precautions
Hand Washing
Infectious/Hazardous Waste Disposal
Supply/Equipment Disposal
Use of Disposable Therrnometer
Use of CPR Mask/Bag

Proper use of Specific Barrier, Methods

Mask / Goggles

Safety and Activity

Determining Patient ID
Identifying Safety Hazards
Determining Need for Additional Help
Assessing Safety and ADL Needs
Recognizing Abuse: Substance, Physical, Emotional, etc.
Maintaining Clean, 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

Belt Including Seat Belt

Care Routines: New Admissions and Transfers

Inventory and Disposition of Belongings, Use of Checklist
Room Orientation, Call Bell

Care Routines: Post-op Patients

Transferring into Bed
Call Bell
Assist with Turns
ROM Exercises

Maintaining 02 Therapy

Replacing Mask or Nasal Caunula if Needed
Notifying Nurse of Problems
Basic Comfort Measures

Preparation For and Transfer to SNF

Early Bath
Preparing Belongings
Preparing for and Explaining Routines to Patient
Post Mortem Care
Use of Incentive Spirometer

Removing /Replacing

Antiembolic Stockings
Sequential Stockings


Using Appropriate Abbreviations
Identifying UnusuaI Patient Incidents that Require Reporting
Reinforcing RN Teaching With Patient
Selecting and Using Forms Appropriately
Using Alternate Communication Tools /Devices

Communicating to RN

Changes in Patient Condition
Patient Needs, Complaints and Concerns
Unusual Incidents

Recording and Reporting

Vital Signs
Bathing /Hygiene
Turning and Repositioning
Ambulation and Activity
Diet intake, Calorie Count
Bowel Movements

1 & 0

Shift Volumes and Totals
Marking and / or Measuring Amount of Urine, Gastric Fluid, NG Drainage, Emesis, Diarrhea

Age Specific Competencies

Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)

Unit Activity

Identifying Unusual Incidents on the Unit that Require Reporting
Locating and Using Appropriate Reference Materials: Hospital, Patient Care
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


The information I have given is true and accurate to the best of my knowledge. I hereby authorize Hired by Matrix, Inc. to release this Case Management Skills Checklist to Client facilities of Hired by Matrix, Inc. in consideration of my assignment to work at those facilities.
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