LPN Skills Checklist
   LAST 4 OF SSN      
I hereby certify that ALL information I have provided to FILL IN THE BLANK 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.  
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

Rating Stars (Click) Skills 1 2 3 4  
Activities of daily living  
Admission of patient  
Administration of medication  
Application of heat and cold   
Aseptic Technique   
Assist with medical examination  
Bathing: Sitz, tub, bed, shower  
Body Alignment  
Body Systems Review (Head to Toe data collection)  
Cast care   
Catheterization / Foley catheter care  
Colostomy Care and irrigation  
Crutch walking  
Decubitus Care   
Diabetic tests and preparation forms   
Diabetic blood glucose testing   
Discharge patients  
Dosage computation   
Dressing (sterile)   
Ear drops  
Elimination needs  
Enemas, cleansing, retention, Harris flush   
Infection Control: Standard Universal Precautions  
Infection Control: Reverse Isolation  
Infection Control: TB/ Airborne Precautions  
Infections Control: MRSA/ VRE Precautions  
Isolation procedure for specimen collection  
IVs: Monitor rate and infusion site  
Medications: Oral, IM, SQ  
Mouth care  
Nail Care  
Neurological Check  
Nutritional check  
Observations: Response to treatments/ meds  
Observations: Signs of significant body system changes  
Observations: Signs of shock  
Observations: Signs of pain  
Observes safety procedures  
O2 administration  
Pain assessment  
Patient care plans (revise and update)  
Patient safety standards/ precautions  
Positioning patient  
Postural drainage  
Pre-op and post-op care  
Provide comfort, safety and privacy  
Pulse oxymetry  
Range of motion  
Report observations/ changes  
Hand hygiene  
Skin care  
Specimen collection: routine urine  
Specimen collection: clean catch   
Specimen collection: 12 & 24 hour specimen   
Specimen collection: stool   
Specimen collection: culture  
Specimen collection: sputum   
Specimen collection: from foley catheter  
Surgical Preps  
Computerized charting   
Trach care/suctioning  
Telephone manners  
Topical Medication Application  
Transfer/ transport patients: wheelchair  
Transfer/ transport patients: gurney  
Transfer/ transport patients: to chair  
Urine test for glucose/ acetone  
Vital Signs  
Weight: Bed scales and standing scales  
IV therapy certified  
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
Infant (Birth - 1 year)  
Preschooler (ages 2-5 years)  
Childhood (ages 6-12 years)  
Adolescents (ages 13-21 years)  
Young Adults (ages 22-39 years)  
Adults (ages 40-64 years)  
Older Adults (ages 65-79 years)  
Elderly (ages 80+ years)