Name: Signal Health Group
Address: 10475 Crosspoint Blvd, Indianapolis, IN, 46256, US
Telephone: 800-953-6183
Price range: $$

Personal Care Assistant Skills Check List
Name:
Check skills beings demonstrated. Initial and dat when each skill in evaluated. Mark met or not met. Initial,sing and date at bottom of form.
Demonstration of Skills

	Date	Met	Not Met	Re-test date	Met	Not Met	Comments
Mobility
* Ambulations:
Assist
Cane,
Walker,
Or Crutches
* ROM: Uper and Lowers
Active
Passive
Transfer:Assist
Wheelchair,or Bed-to-chair
* Positioning
In a Bed or
In a chair
personal Care
* Oral:
Dentures
Natural Teeth,
or Gum Care
* Bed Bath:
	Date	Met	Not Met	Re-test date	Met	Not Met	Comments
Environmental Services
* Linen Change:Bed Occupied With Patient Bed Unoccupied
* Universal: Precautions,as written by the Agency, are used and followed
* Medication assistance Competent Client
* Mentally Incompetent
	Date	Met	Not Met	Re-test date	Met	Not Met	Comments
Other Individual Agency Requirements
Use of special equipment

Personal Care Assistant Skills Check List