Nursing Home Employee Skill Assessment Form

This form is designed to assess the skills and competencies of employees working within our nursing home facility. Please rate each skill/competency based on the employee's performance, with 1 as the highest and 5 as the lowest rating. You may also provide comments or notes as necessary. Thank you for your dedication to providing quality care to our residents.

Employee Information

Name:	[Employee Name]
Job Title:	[Title/Position]
Department:	[Department]
Date of Assessment:	[Assessment Date]

Skills and Competencies

Skill/Competency	Proficiency Rating (1-5)	Comments/Notes
Patient Care
- Bathing/Grooming
- Feeding
- Mobility Assistance
Communication
- Patient Communication
- Family Communication
- Interpersonal Skills
Medication Administration
- Knowledge of Medications
- Proper Administration Techniques
- Documentation
Infection Control Practices
- Hand Hygiene
- Personal Protective Equipment (PPE) Use
- Environmental Cleaning
Safety Protocols
- Fall Prevention
- Emergency Procedures
- Risk Assessment
Documentation and Record-Keeping

Overall Performance Rating:                               

Recommendations for Development/Training

Provide recommendations for development/training to further improve the employee skills:

Evaluator:

[Evaluator Name]

[Date]

Employee:

[Employee Name]

[Date]

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