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Skills Checklist

Geriatric & Long Term Care

Let’s assess your clinical skills and experience. Please rate your experience/frequency (within the last year) using the following scale (check the appropriate boxes):

1 = No theory and/or experience 2 = Limited Experience 3 = Experienced/minimal support needed to perform 4 = Proficient

  • Type of Facility Experience

  • Age of Patients Cared for:

  • General Skills

  • Medications

    Knowledge and Use of:

  • Phlebotomy / IV Therapy

  • Cardiac General

  • Cardiac-Care of Patient with:

  • Knowledge and Use of:

  • Respiratory General

  • Respiratory

    Care of Patient with:

  • Knowledge and Use of:

  • Neuro General

  • Neuro-Care of Patient with:

  • Sensory Deficits

    Care of Patient with:

  • Knowledge and Use of:

  • GI General

  • Gastrointestinal

    Care of Patient with:

  • Endocrine General

  • Endocrine

    Care of Patient with:

  • Knowledge and Use of:

  • Renal/GU General

  • Renal/GU

    Care of Patient with:

  • Orthopedic General

  • Orthopedic

    Care of Patient with:

  • Wound/Skin

    Care of Patient with:

  • Wound/Skin General

  • Additional Skills

    Care of Patient with:
  • MM slash DD slash YYYY

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