= Skills Checklist =

Licensed Practical / Vocational Nurse

Please rank the following skills on a scale of 1 to 4

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

  • Experience with the Following Ages

  • General Medication Administration

  • General Intravenous

  • General Infection Control

  • General Assessment

  • General Body Mechanic/Transfer

  • General Restraints

  • Knowledge and Use of General Equipment

  • General Specimen Collection

  • General Procedures

  • General Communication/Documentation

  • MM slash DD slash YYYY