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1.877.891.4286
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
House Supervisor – Skills Checklist
This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Precision Nationwide Staffing.
0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced
Age of Patients Cared For
Newborn/Neonate (birth - 30 days)
*
0
1
2
3
4
5
Infant (30 days - 1 year)
*
0
1
2
3
4
5
Toddler (1 - 3 years)
*
0
1
2
3
4
5
Preschooler (3 - 5 years)
*
0
1
2
3
4
5
School Age Child (5 - 12 years)
*
0
1
2
3
4
5
Adolescents (12 - 18 years)
*
0
1
2
3
4
5
Young Adults (18 - 39 years)
*
0
1
2
3
4
5
Middle Adults (39 - 64 years)
*
0
1
2
3
4
5
Older Adults (64 - 79 years)
*
0
1
2
3
4
5
Elderly Adults (79+ years)
*
0
1
2
3
4
5
General Skills
Standard Precautions
*
0
1
2
3
4
5
Isolation Precautions
*
0
1
2
3
4
5
Working with patients in restraints
*
0
1
2
3
4
5
Patient/Family Education
*
0
1
2
3
4
5
Patient Identification
*
0
1
2
3
4
5
Specialty Beds
*
0
1
2
3
4
5
End of Life/Palliative Care
*
0
1
2
3
4
5
Collect Appropriate Data
*
0
1
2
3
4
5
Knowledge of current Joint Commission National
*
0
1
2
3
4
5
Electronic Documentation
*
0
1
2
3
4
5
Electronic Documentation - List Types
*
Setting
Acute Care/Hospital
*
0
1
2
3
4
5
SNF/Long Term Care
*
0
1
2
3
4
5
Managed Care
*
0
1
2
3
4
5
Home Health
*
0
1
2
3
4
5
Hospice
*
0
1
2
3
4
5
Outpatient
*
0
1
2
3
4
5
Physician Office
*
0
1
2
3
4
5
Management
Understanding of health care economics and health care policies as it applies to patient care
*
0
1
2
3
4
5
Concepts of Capital Budgeting
*
0
1
2
3
4
5
Department/Unit Budgeting
*
0
1
2
3
4
5
Recruitment Techniques
*
0
1
2
3
4
5
Interviewing Techniques
*
0
1
2
3
4
5
Labor Laws pertaining to hiring
*
0
1
2
3
4
5
Orientation of New Employees
*
0
1
2
3
4
5
Knowledge of Quality Improvement/Performance Improvement Tools
*
0
1
2
3
4
5
Patient Safety
*
0
1
2
3
4
5
Workplace Safety
*
0
1
2
3
4
5
Promotion of Interdepartmental Communication
*
0
1
2
3
4
5
Performance Management
*
0
1
2
3
4
5
Staff Development
*
0
1
2
3
4
5
Coaching and Mentoring
*
0
1
2
3
4
5
Project Management
*
0
1
2
3
4
5
Business Development
*
0
1
2
3
4
5
Developing Strategic Plans
*
0
1
2
3
4
5
Cultural Competence
*
0
1
2
3
4
5
Ethical Behavior and Practice
*
0
1
2
3
4
5
Professional Association Involvement
*
0
1
2
3
4
5
Conflict Management
*
0
1
2
3
4
5
Team Dynamics
*
0
1
2
3
4
5
JCAHO Standards
*
0
1
2
3
4
5
Risk Management/Service Utilization
*
0
1
2
3
4
5
Local Department of Health
*
0
1
2
3
4
5
State Department of Health
*
0
1
2
3
4
5
Sitter Services
*
0
1
2
3
4
5
Other Skills
Please List Any Other Relevant Skills
Information & Agreement
Application ID
*
Please enter your application ID. This ID should be 15 characters long and have the format of PHNMS##########. You should have received an email containing your application ID when you submitted your initial application. If not, please contact our staff.
Applicant Name
*
First
Last
Applicant Email
*
Applicant Phone
*
I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.
*
I agree to the terms below.
The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Precision Nationwide Staffing. Submit this skills evaluation with your initial application. To be updated annually.
Signature
*
