Personal Information

*Please fill the email ID correctly for successful submission

Legends

1 = No experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

I hereby certify that ALL information I have provided to Tricehealthcare on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Legends

Experience

Set Up / Initiate Dialysis Treatment

Assess Patient and Equipment During Dialysis

Machine Alarm Troubleshooting Procedures

Discontinue Dialysis

Care of Patient with

Age Specific Skills