CNA Self Assessment - GoMed Healthcare

Follows the resident's plan of care:

Proficiency:

Frequency:

Understands job description and duties:

Proficiency:

Frequency:

Adheres to federal and state regulatory laws/guidelines affecting resident care:

Proficiency:

Frequency:

Understands basic supportive care for residents with multiple medical conditions:

Proficiency:

Frequency:

Maintains knowledge of basic life support, Heimlich maneuver, and AED:

Proficiency:

Frequency:

Follows chain of command for job role:

Proficiency:

Frequency:

Completes inventory of resident's personal belongings and labels them:

Proficiency:

Frequency:

Assists with equipment/room set up:

Proficiency:

Frequency:

Provides the resident orientation to their room:

Proficiency:

Frequency:

Assists resident with personal belongings:

Proficiency:

Frequency:

Assists with transport of resident (e.g., wheelchair):

Proficiency:

Frequency:

Respects cultural and diverse beliefs:

Proficiency:

Frequency:

Adheres to HIPAA laws:

Proficiency:

Frequency:

Understands Resident Rights:

Proficiency:

Frequency:

Provides person-centered care:

Proficiency:

Frequency:

Provides introduction of self to resident and explains all care actions:

Proficiency:

Frequency:

Actively listens to resident concerns:

Proficiency:

Frequency:

Uses English and Metric conversions to calculate measurements:

Proficiency:

Frequency:

Documents care provided within required timeframes:

Proficiency:

Frequency:

Records vital signs:

Proficiency:

Frequency:

Reads and documents time correctly:

Proficiency:

Frequency:

Uses electronic documentation methods (e.g., computer, tablets):

Proficiency:

Frequency:

Uses checklist and flowsheet documentation methods:

Proficiency:

Frequency:

Follows organizational policy and procedure for reporting events (e.g., fall, injury, missing personal items):

Proficiency:

Frequency:

Identifies and reports information that is considered an indicator of abuse or neglect:

Proficiency:

Frequency:

Reports concerns of the resident/family/caregiver per organizational policy and procedure:

Proficiency:

Frequency:

Identifies signs and symptoms of a resident in pain:

Proficiency:

Frequency:

Uses correct procedure to obtain tympanic temperature:

Proficiency:

Frequency:

Performs Flossing:

Proficiency:

Frequency:

Cares for Dentures (Full and Partial):

Proficiency:

Frequency:

Performs Oral Hygiene for Conscious and Unconscious Residents:

Proficiency:

Frequency:

Performs Mouth Care (e.g., Oral Swabs, Lip Lubricant):

Proficiency:

Frequency:

Brushes Teeth:

Proficiency:

Frequency:

Files Nails:

Proficiency:

Frequency:

Observes and Reports Abnormal Findings (e.g., color, texture, bruising):

Proficiency:

Frequency:

Follows Organizational Policy and Procedure for Nail and Foot Care:

Proficiency:

Frequency:

Trims Nails:

Proficiency:

Frequency:

Performs a Complete Bed Bath:

Proficiency:

Frequency:

Assists with Whirlpool Bath:

Proficiency:

Frequency:

Performs a Partial Bed Bath:

Proficiency:

Frequency:

Shampoos Hair (Sink, Tub, Bed):

Proficiency:

Frequency:

Assists with Tub Bath:

Proficiency:

Frequency:

Performs Shower:

Proficiency:

Frequency:

Uses Electric Razor:

Proficiency:

Frequency:

Uses Disposable Safety Razor:

Proficiency:

Frequency:

Checks Resident’s Plan of Care for Bleeding Precautions:

Proficiency:

Frequency:

Provides Privacy During Dressing and Undressing:

Proficiency:

Frequency:

Dresses and Undresses Conscious and Unconscious Residents:

Proficiency:

Frequency:

Dresses and Undresses a Resident with a Weak Side:

Proficiency:

Frequency:

Applies TED/Support Stockings:

Proficiency:

Frequency:

Allows the Resident to Choose Their Clothing:

Proficiency:

Frequency:

Dresses and Undresses a Resident with an Intravenous Line:

Proficiency:

Frequency:

Provides Proper Care of Eyeglasses:

Proficiency:

Frequency:

Provides Proper Care of Hearing Aids and Devices:

Proficiency:

Frequency:

Provides Proper Care of a Prosthetic Eye:

Proficiency:

Frequency:

Provides Proper Care of Contact Lenses:

Proficiency:

Frequency:

Makes Occupied Beds:

Proficiency:

Frequency:

Handles Clean Linens Appropriately:

Proficiency:

Frequency:

Properly Disposes of Soiled Linen:

Proficiency:

Frequency:

Makes Unoccupied Beds:

Proficiency:

Frequency:

Positions and turns the resident to prevent skin problems:

Proficiency:

Frequency:

Uses proper skin care techniques:

Proficiency:

Frequency:

Keeps the skin clean and dry:

Proficiency:

Frequency:

Reports abnormal and new skin problems to the RN/charge nurse:

Proficiency:

Frequency:

Massages the Back:

Proficiency:

Frequency:

Correctly positions the resident during and after feeding:

Proficiency:

Frequency:

Reports abnormal observations (e.g., trouble swallowing, refusal of meals):

Proficiency:

Frequency:

Assists resident with menu selection:

Proficiency:

Frequency:

Follows aspiration precautions:

Proficiency:

Frequency:

Follows the resident's diet listed on the plan of care:

Proficiency:

Frequency:

Understands special diets:

Proficiency:

Frequency:

Prepares food (e.g., opening containers, cutting up food):

Proficiency:

Frequency:

Uses assistive devices properly (e.g., built-up utensils, plate guard):

Proficiency:

Frequency:

Uses proper feeding techniques with and without assistive devices:

Proficiency:

Frequency:

Provides the resident with respect and privacy during toileting and elimination:

Proficiency:

Frequency:

Assists resident using a toilet riser:

Proficiency:

Frequency:

Assists resident with urinal use:

Proficiency:

Frequency:

Empties colostomy bag:

Proficiency:

Frequency:

Provides colostomy care and assistance:

Proficiency:

Frequency:

Follows the bowel and bladder training plan:

Proficiency:

Frequency:

Provides catheter care (e.g., indwelling, condom):

Proficiency:

Frequency:

Provides care to a resident with self-harm behaviors or suicidal ideations:

Proficiency:

Frequency:

Provides end-of-life care for a resident:

Proficiency:

Frequency:

Provides care for resident with DNR order:

Proficiency:

Frequency:

Provides post-mortem care in accordance with cultural and religious considerations/preferences:

Proficiency:

Frequency:

Provides care for a resident with developmental disabilities:

Proficiency:

Frequency:

Provides care for a resident who is combative:

Proficiency:

Frequency:

Provides care for a resident with cancer or other terminal diagnosis:

Proficiency:

Frequency:

Understands and follows chemical storage protocols:

Proficiency:

Frequency:

Understands and follows fire safety protocols:

Proficiency:

Frequency:

Uses a fire extinguisher:

Proficiency:

Frequency:

Understands the importance of disaster preparedness:

Proficiency:

Frequency:

Understands and follows the evacuation plan:

Proficiency:

Frequency:

Reports issues with the resident's room (lighting, furniture, housekeeping):

Proficiency:

Frequency:

Assists with Transport of Resident (e.g., wheelchair):

Proficiency:

Frequency:

Uses support devices (e.g., leg/wrist brace, wedge, elastic stockings):

Proficiency:

Frequency:

Transfers resident using safe transfer techniques:

Proficiency:

Frequency:

Understands and follows aspiration precautions:

Proficiency:

Frequency:

Understands and follows fall precautions:

Proficiency:

Frequency:

Identifies residents using two unique identifiers prior to care:

Proficiency:

Frequency:

Understands and follows suicide precautions:

Proficiency:

Frequency:

Understands and follows bleeding precautions:

Proficiency:

Frequency:

Follows airborne precautions when required:

Proficiency:

Frequency:

Follows contact precautions when required:

Proficiency:

Frequency:

Follows standard precautions at all times:

Proficiency:

Frequency:

Performs hand hygiene:

Proficiency:

Frequency:

Follows droplet precautions when required:

Proficiency:

Frequency:

Uses appropriate PPE (e.g., gloves, gowns, masks, respirators):

Proficiency:

Frequency:

Appropriately applies and removes masks/respirators:

Proficiency:

Frequency:

Appropriately applies and removes protective eyewear/face shields:

Proficiency:

Frequency

Appropriately applies and removes gloves:

Proficiency:

Frequency:

Appropriately applies and removes gowns/aprons:

Proficiency:

Frequency:

Appropriately applies and removes shoe covers:

Proficiency:

Frequency:

Obtains stool specimen:

Proficiency:

Frequency:

Properly labels specimens:

Proficiency:

Frequency:

Obtains emesis specimen:

Proficiency:

Frequency:

Obtains urine specimen (e.g., clean catch):

Proficiency:

Frequency:

Uses bed alarm, if applicable, per organizational policy:

Proficiency:

Frequency:

Understands the use of therapeutic beds:

Proficiency:

Frequency:

Understands the use of a bed scale:

Proficiency:

Frequency:

Recognizes bed positions:

Proficiency:

Frequency:

Understands the use of therapeutic mattresses:

Proficiency:

Frequency:

Uses adjustable bed properly/appropriately:

Proficiency:

Frequency:

Uses Hoyer lift with proper sling size:

Proficiency:

Frequency:

Uses sit-to-stand lift:

Proficiency:

Frequency:

Adolescent (12-18 years):

Proficiency:

Frequency:

Elderly (>60 years):

Proficiency:

Frequency:

First Name:

Last Name:

Birthdate (MM/DD/YYYY):

Years of Experience in Clinical Specialty:

Most Recent Facility Worked At:

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GoMed Healthcare

CNA Self-Assessment

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GoMed Healthcare

CNA Self-Assessment

Section 1: Provision of Care - General (6 Questions)

Section 2: Resident Admission (3 Questions)

Section 3: Resident Discharge (2 Questions)

Section 4: Resident Rights (4 Questions)

Section 5: Communication - Effective Communication Skills (2 Questions)

Section 6: Communication - Documentation (4 Questions)

Section 7: Communication - Methods of Documentation (2 Questions)

Section 8: Communication - Reporting (3 Questions)

Section 9: Communication - Vital Signs (2 Questions)

Section 10: Resident Care - Oral Hygiene (5 Questions)

Section 11: Resident Care - Nail and Foot Care (4 Questions)

Section 12: Resident Care - Bathing Techniques (6 Questions)

Section 13: Resident Care - Shaving Techniques (3 Questions)

Section 14: Resident Care - Dressing and Undressing Techniques (6 Questions)

Section 15: Resident Care - Vision and Hearing Aids (4 Questions)

Section 16: Resident Care - Bedmaking Techniques (4 Questions)

Section 17: Resident Care - Skin Care (5 Questions)

Section 18: Resident Care - Nutrition (9 Questions)

Section 19: Resident Care - Toileting and Elimination (7 Questions)

Section 20: Resident Care - Special Care (7 Questions)

Section 21: Resident Care - Environmental Safety (6 Questions)

Section 22: Resident Care - Mobility and Transfer (3 Questions)

Section 23: Resident Care - Safety Precautions (5 Questions)

Section 24: Infection Control - Standard/Universal Precautions (5 Questions)

Section 25: Infection Control - Personal Protective Equipment (PPE) (6 Questions)

Section 26: Infection Control - Specimen Collection (4 Questions)

Section 27: Equipment - Beds (6 Questions)

Section 28: Equipment - Proper Use of Mechanical Lifts (2 Questions)

Section 29: Age-Specific Care (2 Questions)

Section 30: Summary (6 Items)

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