Skill Checklists

RN Occupational and Employee Health Skills

This checklist was electronically signed on (Today’s date)

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

Trauma

Care of Patient with:

Minor Trauma

Major Trauma

MAST Suit

Bruns

Care of Patient with:

First Degree

Second Degree

Third Degree

Electrocution

Hazardous Materials Exposure

Lacerations

Care of Patient with:

Assessment

Cleansing

Steri-Strips

Dressing

Sprain/ Strain

Assessment

Carpal Tunnel

Tendonitis

Epicondylitis

Physical

Safety

Return to Work

Respirator

Vital Signs

Height/Weight

Blood Draw

Medical Referral Form

Medical Certification Form

Medical History Questionnaire

Potassium Iodine Assessment

Restrictions

Temporary Restrictions

Permanent Restrictions

Pulmonary Function

Audiometry

Vision Testing

X-ray

Urine Testing

Drug Testing

Breathalyzer

IMMUNIZATIONS

Havrix (Hepatitis A)

Influenza Vaccine

Meningitis Vaccine

Tetanus & Diphtheria

Oral Typhoid Vaccine

Polio Vaccine

Hepatitis B Vaccine

Japanese Encephalitis B

Rabies Vaccine

Typhim (Injectable Type)

Yellow Fever Vaccine

Age Specific Criteria

Newborn/Neonate (birth-30 days)

Infant (30 days - 1 year)

Toddler (1-3 years)

Preschooler (3-5 years)

School Age Children (5-12 years)

Adolescents (12-18 years)

Young Adults (18-39 years)

Middle Adults (39-64 years)

Older Adults (64+)

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.