PCA/HHA Annual Competency Assessment – Skills Checklist    (1hr inservice)

Employee's Name:    Patient Initials:   Aides Title:PCAHHA

Skills Validation

Competency:  S – Satisfactory   U – Unsatisfactory       Method of evaluation:   DO – Direct Observation      VR – Verbal Response       WE – Written Exam               OT - Other

	Competency	Method of Evaluation	Initials
Handwashing/Universal Precautions	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Proper body mechanics	SatisfactoryUnsatisfactory	-Select one-Direct ObservationVerbal ResponseWritten ExamInserviceInserviceOther
Tub or shower bath	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Bed bath / Sponge bath	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Shampoo / Hair Care	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Nail care / Oral care	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Shaving the Client	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Meal prep – simple diets	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Assist with grooming / Dressing	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Helping the client walk – ambulation/walker/cane	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Making an unoccupied / occupied bed	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Use of a bedpan/ urinal	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Peri care with catheter / emptying or cleaning  catheter bag	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Transfer client to sitting position, assist to sit at side of bed, assist to stand	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Transfer to/from  wheelchair / chair / commode	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Wheelchair safety	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Measuring intake / urine output	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Assisting with changing a clean dressing	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamOtherInservice
Care of infant/children	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Hoyer lift use / sliding board	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Assist with medications for self-directing clients (6 rights)	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Assist with Active Range of Motion (AROM) - coaching, reading, counting and supporting joints as requested	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Assist with obtaining and recording the client's weight	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Skin care positioning with the client in the bed and/or chair	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Review and observe the clients home safety and healthy environment	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther
Toileting or incontinence care - bedpan/urinal/incontinence brief/commode	SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamInserviceOther

Temperature O/R/A	-select one-SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamOther
Respiration/Pulse/BP	-select one-SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamOther
Prescribed exercises /PROM	-select one-SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamOther
Special skin Care	-select one-SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamOther
Assist with dressing change	-select one-SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamOther
Assist with ostomy care	-select one-SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamOther
Complex modified diets	-select one-SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamOther
Oxygen management	-select one-SatisfactoryUnsatisfactory	-select one-Direct ObservationVerbal ResponseWritten ExamOther

 

 

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