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 Experience / Observed Only
  • 2
    = Limited Experience / Rarely Done (<6 times/year)
  • 3
    = May Need Some Review / Occasionally Done (1 - 2 times/month)
  • 4
    = Experienced / Frequently Done (daily or weekly)
  • 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:
  • Date Format: MM slash DD slash YYYY