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LPN Skill Checklist

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Timeframe(Required)

Assessments

Home safety check and environmental(Required)
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Socio-psychological evaluation of the support systems ongoing(Required)
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Documentation according to policy (Nursing Note etc.).(Required)
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Evaluation of ADL and iADLs & reporting to RN(Required)
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Infection Control

Bag Technique(Required)
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Hand washing(Required)
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Standard precautions(Required)
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PPE(Required)
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Plan of Care

Tasks performed only if on POC(Required)
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Determination of medical necessity for other services(Required)
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Teaching

Use of appropriate materials as necessary(Required)
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Topics: disease process/medication mgt/diet/disease management(Required)
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Employs methods for all types of learners(Required)
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Vital Signs

BP(Required)
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HR(Required)
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RR(Required)
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O2 sat(Required)
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Coordination/Communication With

Physician(Required)
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Agency Care team(Required)
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Patient/family(Required)
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Supervisor(Required)
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Case conferences(Required)
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Understanding practice limitations in LPN role(Required)
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*S = SATISFACTORY    U = UNSATISFACTORY    NA = NON-APPLICABLE

I attest that I am a licensed RN and have determined that the above named employee has successfully completed these skills.

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