This checklist was electronically signed on
September 12, 2026
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
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
PATIENT RIGHTS
COMMUNICATION
GENERAL INFECTION CONTROL MEASURES
TRANSMISSION-BASED PROTOCOL
PRE – TRANSPORT
DURING TRANSPORT
POST – TRANSPORT
NEUROLOGIC ASSESSMENT
CARE OF PATIENT WITH NEUROLOGIC DISEASE
INTERPRETATION OF NEUROLOGICAL LABORATORY RESULTS
RESPIRATORY ASSESSMENT
AIRWAY MANAGEMENT DEVICES/SUCTIONING
OXYGEN THERAPY DELIVERY SYSTEMS
CARE OF PATIENT WITH RESPIRATORY DISEASE
HEMODYNAMIC MONITORING, NON-INVASIVE
HEMODYNAMIC MONITORING, INVASIVE
INTERPRETATION OF CARDIOVASCULAR LABORATORY RESULTS
CARE OF PATIENT WITH CARDIOVASCULAR DISEASE
CARDIOVASCULAR EQUIPMENT AND PROCEDURES
GASTROINTESTINAL ASSESSMENT
INTERPRETATION OF GASTROINTESTINAL LABORATORY RESULTS
FEEDINGS
CARE OF PATIENT WITH GASTROINTESTINAL DISEASE
RENAL ASSESSMENT
INTERPRETATION OF RENAL LABORATORY RESULTS
CARE OF PATIENT WITH RENAL DISEASE
INTERPRETATION OF ENDOCRINE/METABOLIC LABORATORY RESULTS
CARE OF PATIENT WITH ENDOCRINE/METABOLIC DISEASE#
ORTHOPEDIC ASSESSMENT
CARE OF PATIENT WITH ORTHOPEDIC DISEASE
INTERPRETATION OF HEMATOLOGY/ONCOLOGY LABORATORY RESULTS
CARE OF PATIENT WITH HEMATOLOGIC/ONCOLOGIC DISEASE
ADMINISTRATION OF BLOOD/BLOOD PRODUCTS
INTERPRETATION OF INFECTIOUS DISEASE LABORATORY RESULTS
CARE OF PATIENT WITH INFECTIOUS DISEASE
WOUND MANAGEMENT
PAIN MANAGEMENT
EQUIPMENT AND PROCEDURES
MEDICATION ADMINISTRATION/PHLEBOTOMY/IV THERAPY MANAGEMENT
CARE OF PATIENT WITH PHLEBOTOMY/IV THERAPY
MISCELLANEOUS
MEDICATIONS
AUTOMATED MEDICATION DISPENSING SYSTEMS
ELECTRONIC DOCUMENTATION
AGE-SPECIFIC COMPETENCIES