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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