Nursing Home Employee Skill Assessment Form
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]
