HHA Competency - ESSENTIAL HEALTHCARE SERVICES INC

don@essential-hcs.com
(813) 549-6123

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Schedule Appointment

HHA Competency

Date(Required)

MM slash DD slash YYYY

Timeframe(Required)

On Hire

Annual

Review

Staff Name(Required)

Supervisor Name(Required)

*S = SATISFACTORY U = UNSATISFACTORY NA = NON-APPLICABLE

*** Proficiency must be demonstrated satisfactorily to perform the task independently.

1.1 Reading & Recording

Temperature(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Pulse(Radia)(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Respirations(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.2 Bathing

Bed Bath(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Tub Bath(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Shower Bath(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Sponge Bath(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.3 Nail Care (No Cutting)

Fingernails(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Toenails(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.4 Skin Care

Backrub(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Incontinent Patient(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Foot Soaks(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Pericare(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

TED Hose(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Shave(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.6 Hair Shampoo in Sink

Hair Shampoo in Sink(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Hair Shampoo in Bed(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Hair Shampoo in Tub(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.7 Oral Hygiene

Brush Teeth(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Denture Care(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Toothettes(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.8 Toileting/Elimination

Urinal Placement(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Bedpan Placement(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.9 Safe Transfer Techniques

Bed to Chair(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Chair to Standing(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Assist w/ambulating(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Transfer Belt(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.10 Normal Range of Motion

Passive ROM Exercises(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Active ROM Exercises(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.11 Ambulation: Assistive Devices

Walker(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Cane(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.12 Positioning

Turn Side to Side(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Assist(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

1.13 Communication Skills

Ability to Read(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Ability to Write(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Ability to Verbally Report Clinical info to Patients/rep/Caregivers/agency Staff(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Section 2: Tasks assessed through written or oral examination, or after observation of a HHA with a patient

Observation, reporting, and documentation of patient status and the care/service furnished(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Basic elements of body functioning and changes in body function that must be reported to an aide’s supervisor.(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Maintenance of a clean, safe, and healthy environment(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Recognizing emergencies and the knowledge of institute emergency procedures and their application(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

The physical, emotional, and developmental needs of and ways to work with the populations served by the HHA, including the need for respect for the patient, his or her privacy, and his or her property(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Adequate nutrition and fluid intake(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Recognizing and reporting changes in skin condition(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

2.6 Meal Preparation

Feeding(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Special diets(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

2.7 Infection Control

Hand Washing(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Proper Bag Technique(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Use of PPE(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Standard Precautions(Required)

S

U

NA

Date(Required)

MM slash DD slash YYYY

Observer Initials(Required)

Methodology Observation(Required)

Evaluator Signature/Titel

Agency Name

Employee Signature(Required)

Date of Completion(Required)

MM slash DD slash YYYY

License No. 299996060

Certificate No. 65167

Get In Touch

(813) 549-6123
(813) 524-6364
don@essential-hcs.com
13506 N. Rome Avenue Suite #102 Tampa, Florida 33613

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