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EVV
Home
About
Services
Skilled Services
Nursing Services
Wound Care
Ostomy Care
Catheter Care
G-Tube Feeding
Vital Signs Monitoring And Report To PCP Doctor
Safety Supervision
Symptom Monitoring
Mobility Support
Speech Therapy
Evaluation/Diagnosis/Prevention of speech impairment
Swallow evaluation and management
Cognitive communication
Medical Social Worker
Providing adequate resources for clients in the community
Implement Short/long term planning of care
Physical Therapy
Improve Mobility & Strength
Aid inside/outside ambulation
Range of motion, Positioning & Transfers
Balancing & Gait
Create an exercise plan
Occupational Therapy
Restore Function
Promote ADL functions
Non-Skilled Services
Home Health Aide
Medication reminders
Vital signs monitoring & Report to Clinical Nurse
Mobility support
Forms
Administrator Competency & Job Description Form
Clinical Manager Job Description Form
Home Health Aide Competency & Job Description & Skill Validation
LPN Competency Job Description Form
MSW Competency Job Description Form
Occupational Therapist Assistant Job Description Form
Occupational Therapist Job Description Form
Physical Therapist Assistant Job Description Form
Physical Therapist Job Description Form
RN Job Description & Performance Evaluation & Competency Form
Speech Therapist Job Description Form
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Alora/EVV
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EVV
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>
Home Health Aide Annual Competency
Home Health Aide Annual Competency
Scroll
Name
(Required)
Date of Hire
(Required)
MM slash DD slash YYYY
Date Completed
(Required)
MM slash DD slash YYYY
Verbalizes and demonstrates understanding of the following:
1) Self-Assessment
Proficient
Need Review
No Experience
1. Communication skills, including the ability to read, write, and verbally report clinical information to patients, representatives, and caregivers, as well as to other agency staff
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Basic elements of body functioning and changes in body function that must be reported to an aide's supervisor
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3. Maintenance of a clean, safe, and healthy environment
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. The physical, emotional, and developmental needs of and ways to work with the populations served by the HHA, including the need for respect for the patient, his or her privacy, and his or her property
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
Need Review
No Experience
5. Recognizing emergencies and the knowledge of instituting emergency procedures and their application
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Reading and Recording:
1) Self-Assessment
Proficient
Need Review
No Experience
1. Blood pressure
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Temperature
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3. Pulse
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. Respiration
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Demonstrates appropriate and safe techniques in performing personal hygiene and grooming tasks that include:
1) Self-Assessment
Proficient
Need Review
No Experience
1. Bathing:
Sponge bath
Tub bath
Shower
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2.Hair shampooing
Sink
Tub
Bed
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3. Nail care
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Preceptor Initials
(Required)
4) Self-Assessment
Proficient
Need Review
No Experience
4. Skin care
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
Need Review
No Experience
5. Oral Hygiene
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficient
Need Review
No Experience
6. Toileting and Elimination
Urinal
Bedpan
Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
7) Self-Assessment
Proficient
Need Review
No Experience
7. Safe transfer techniques:
Bed to chair
Chair to standing
Assist with ambulation
Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
8) Self-Assessment
Proficient
Need Review
No Experience
8. Normal range of motion
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
9) Self-Assessment
Proficient
Need Review
No Experience
8. Positioning
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
10) Self-Assessment
Proficient
Need Review
No Experience
9. Adequate nutrition and fluid intake
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
11) Self-Assessment
Proficient
Need Review
No Experience
11. Meal Preparation
Feeding
Diabetic diet
Low sodium
Low cholesterol/fat
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
12) Self-Assessment
Proficient
Need Review
No Experience
12. Recognizing and reporting changes in skin condition
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
13) Self-Assessment
Proficient
Need Review
No Experience
13. Light housekeeping (patient area)
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
14) Self-Assessment
Proficient
Need Review
No Experience
14. Change linen/make bed
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Equipment/assistive devices:
1) Self-Assessment
Proficient
Need Review
No Experience
1. Walker
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Cane
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3. Gait belt
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. Hoyer lift
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
Need Review
No Experience
5. Shower chair/transfer bench
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficient
Need Review
No Experience
6. Oxygen cylinder/concentrator/portable
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Documentation Skills (legible, timely, accurate and complete):
1) Self-Assessment
Proficient
Need Review
No Experience
1. Observation, reporting, and documentation of patient status and the care or service furnished
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Adheres to POC
(Required)
Reviews POC prior to care
Performs services as ordered
Documents according to POC and CMS/state requirements
Communicates/coordinates as appropriate
Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Infection Control:
1) Self-Assessment
Proficient
Need Review
No Experience
1.Hand washing
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Proper bag technique
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3. Protective equipment
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. Equipment care
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
Need Review
No Experience
5. Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Comments
Employee Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Supervisor Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Preceptor Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Preceptor Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Preceptor Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Δ
Search for:
Home
About
Services
Skilled Services
Nursing Services
Wound Care
Ostomy Care
Catheter Care
G-Tube Feeding
Vital Signs Monitoring And Report To PCP Doctor
Safety Supervision
Symptom Monitoring
Mobility Support
Speech Therapy
Evaluation/Diagnosis/Prevention of speech impairment
Swallow evaluation and management
Cognitive communication
Medical Social Worker
Providing adequate resources for clients in the community
Implement Short/long term planning of care
Physical Therapy
Improve Mobility & Strength
Aid inside/outside ambulation
Range of motion, Positioning & Transfers
Balancing & Gait
Create an exercise plan
Occupational Therapy
Restore Function
Promote ADL functions
Non-Skilled Services
Home Health Aide
Medication reminders
Vital signs monitoring & Report to Clinical Nurse
Mobility support
Forms
Administrator Competency & Job Description Form
Clinical Manager Job Description Form
Home Health Aide Competency & Job Description & Skill Validation
LPN Competency Job Description Form
MSW Competency Job Description Form
Occupational Therapist Assistant Job Description Form
Occupational Therapist Job Description Form
Physical Therapist Assistant Job Description Form
Physical Therapist Job Description Form
RN Job Description & Performance Evaluation & Competency Form
Speech Therapist Job Description Form
Resources
Employement
Alora/EVV
Alora
EVV
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