Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
    Proficiency Scale:

    1 = No Experience (Theory or observation only during the past 12 months)

    2 = Limited Experience (Performed less than 12 times within the past 12 months and may need a review)

    3 = Experienced (Performed at least once per month within the past 12 months and may need minimal assistance)

    4 = Highly Skilled (Performed on at least a weekly basis over the past 12 months; proficient)

    Rating Stars (Click)

    Vital Measurements

    Blood Glucose Monitoring

    Measure and Record I & O

    Measure Blood Pressure

    Measure Orthostatic BP

    Measure Pulse

    Measure Respirations

    Measure Temperature – Axillary

    Measure Temperature – Oral

    Measure Temperature – Rectal

    Measure Temperature - Tympanic

    Rating Stars

    Patient Care and ADL’s

    Administer Enemas

    Bed Making Occupied

    Bed Making Unoccupied


    Bedside Commode

    Care of a Combative Patient

    Care of a Confused Patient

    Care of a Suicidal Patient

    Complete Bed Bath

    Denture Care

    Foley Care

    Foot Care

    Oral Hygiene

    Post Mortem Care

    Provide Perineal Care

    Range of Motion

    Shower with Assistance


    By submitting this checklist, I hereby certify that ALL information I have provided 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.