Personal Information

*Please fill the email ID correctly for successful submission

Proficiency Level:

1 – No experience; Theory/observed only

2 – Limited competency; < 5 times per year; Needs supervision

3 – Acceptable competency; > 5 times per year

4 – Competent; Performs on a daily or weekly basis; Proficient

Neuro

Cerebral Vascular Accident

Coma Patients

Head Trauma

Spinal Cord Injury

Parkinson's Disease

Traumatic Brain Injury

Neuromuscular Disease

Post Craniotomy

Bowel/Bladder Programs

Restraints

4pt

Shoulder Strap

Hand Mitts

Wrist

Ankle

Pelvic Strap

Pulmonary

Assessment of breath sounds

Chest Physiotherapy

Oximetry

Nasal cannula

Face Mask

Portable O2 tank

Nasotracheal Suctioning

Tracheal Suctioning

Care of patient w/Mechanical Vent

COPD

Nutritional Requirements

Thickened Liquids

Minimal

Thick

Extra Thick

Pudding Thick

NG Tubes

Peg Tubes

I certify that all the above information is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency. I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Proficiency Level:

Work Settings

Neuro

Ortho

Restraints

EMR

Pulmonary

Pediatrics

Nutritional Requirements

Other