Student Name___________________________________ Class_______________________
Arizona Nursing Assistant Skills Checklist: Clinical
*Students may not perform skills on residents/patients until they have demonstrated competency
and been signed off by a RN in the skills laboratory.
Testable
Clinical Practice
Date
Student
Initials
RN
Initials
Ambulation with Gait Belt
Ambulation with Walker
Applying Antiembolic Stockings
Bedpan and Output
Bed Bath-Whole Face, One Arm, and Underarm
Blood Pressure -Manual
Denture Care
Dressing Bedridden Resident
Feeding the Dependent Resident
Fluid Intake
Isolation Gown and Gloves
Mouth Care-Brushing teeth
Mouth Care of Comatose Resident
Making an Occupied Bed
Perineal Care-Female
Perineal Care-Male with a Soiled Brief
Positioning Resident on Side
Range of Motion Hip and Knee
Range of Motion Shoulder
Pivot Transfer a Wt. Bearing, Non-Ambulatory
Resident from W/C to Bed using Gait Belt
Pivot transfer a Wt. Bearing, Non-Ambulatory
Resident from Bed to W/C using Gait Belt
Vital Signs TPR
Vital Signs TR, Pulse Oximetry, Electronic BP
Non-Testable
Clinical Practice
Date
Student
Initials
RN
Initials
Apply Clean Bandages
Assist in Admitting Resident
Assist in Discharging Resident
Assist in Transferring Resident
Classroom Practice
Date
Student
Initials
RN
Initials
Assist with Diagnostic Test/Obtains Specimen
Back Rub
Body Mechanics
Care/ Use of Prosthetic or Orthotic Devices
Catheter Care
Documenting ADLs
Donning/Removing Gown/Gloves/Mask
Dress Resident
Empty Catheter and Measure Output
Fingernail Care
Handwashing/Hand Hygiene
Maintaining a Resident’s Environment
Make an Unoccupied Bed
Mechanical Lift Transfer
Move Resident Up in Bed
Observe, Report Pain
Ostomy Care
Pass and Set Up Trays
Perioperative Care
Post Mortem Care
Provide Care for Patients with Drains
Provide Care of Patients with Feeding Tubes
Range of Motion Exercises
Recognizing and Reporting abnormal physical,
psychological or mental changes
Record Meal Percentage and Intake
Report Skin Condition
Shampoo and Hair Care
Shaving
Shower
Skin Care
Toileting
Transfer and Position Resident in Chair
Use of Assistive Devices in Feeding
Use of Assistive Devices in Transferring,
Ambulating, and Dressing
Weight- Standing, W/C and Bed Scales
Student Signature_____________________________________________________
RN Clinical Instructor Signature _________________________________________________Initials__________
Program Completion Date __________________________
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