Age Specific Care
Proficiency Rating
Frequency Rating
Newborn/Neonate (birth - 30 days) *
Newborn/Neonate (birth - 30 days) proficiency* Newborn/Neonate (birth - 30 days) frequency* Infant (30 days - 1 year) *
Infant (30 days - 1 year) proficiency* Infant (30 days - 1 year) frequency* Toddler (1 - 3 years) *
Toddler (1 - 3 years) proficiency* Toddler (1 - 3 years) frequency* Preschooler (3 - 5 years) *
Preschooler (3 - 5 years) proficiency* Preschooler (3 - 5 years) frequency* School Age Child (5 - 12 years) *
School Age Child (5 - 12 years) proficiency* School Age Child (5 - 12 years) frequency* Adolescents (12 - 18 years) *
Adolescents (12 - 18 years) proficiency* Adolescents (12 - 18 years) frequency* Young Adults (18 - 39 years) *
Young Adults (18 - 39 years) proficiency* Young Adults (18 - 39 years) frequency* Middle Adults (39 - 64 years) *
Middle Adults (39 - 64 years) proficiency* Middle Adults (39 - 64 years) frequency* Older Adults (64+ years) *
Older Adults (64+ years) proficiency* Older Adults (64+ years) frequency* Elderly Adults (over 79+ years) *
Elderly Adults (over 79+ years) proficiency* Elderly Adults (over 79+ years) frequency* Name*
First
Last
General Skills
Proficiency Rating
Frequency Rating
Standard Precautions *
Standard Precautions proficiency* Standard Precautions frequency* Isolation Precautions *
Isolation Precautions proficiency* Isolation Precautions frequency* Patient / Family Education *
Patient / Family Education proficiency* Patient / Family Education frequency* CMS Regulations *
CMS Regulations proficiency* CMS Regulations frequency* DNV Regulations *
DNV Regulations proficiency* DNV Regulations frequency* APIC Regulations *
APIC Regulations proficiency* APIC Regulations frequency* CDC Regulations *
CDC Regulations proficiency* CDC Regulations frequency* Electronic Documentation *
Electronic Documentation proficiency* Electronic Documentation frequency*
Practice Settings
Proficiency Rating
Frequency Rating
Acute Care *
Acute Care proficiency* Acute Care frequency* Long-Term Care *
Long-Term Care proficiency* Long-Term Care frequency* Health Department / Other Agency *
Health Department / Other Agency proficiency* Health Department / Other Agency frequency*
Assessment and Patient Care
Proficiency Rating
Frequency Rating
Knowledge of MDROs *
Knowledge of MDROs proficiency* Knowledge of MDROs frequency* Make written and oral reports / recommendations concerning the infection control program of the facility *
Knowledge of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to infection control proficiency* Knowledge of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to infection control frequency* Make written and oral reports / recommendations concerning the infection control program of the facility *
Make written and oral reports / recommendations concerning the infection control program of the facility proficiency* Make written and oral reports / recommendations concerning the infection control program of the facility frequency* Plan, develop, organize, implement, evaluate, coordinate, and direct infection control program in accordance with current rules, regulations and guidelines *
Plan, develop, organize, implement, evaluate, coordinate, and direct infection control program in accordance with current rules, regulations and guidelines proficiency* Plan, develop, organize, implement, evaluate, coordinate, and direct infection control program in accordance with current rules, regulations and guidelines frequency* Possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies, procedures, etc., that are necessary for preventing and controlling infections, to include the establishing of universal precautions *
Possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies, procedures, etc., that are necessary for preventing and controlling infections, to include the establishing of universal precautions proficiency* Possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies, procedures, etc., that are necessary for preventing and controlling infections, to include the establishing of universal precautions frequency* Seek out new methods and principles and incorporate them into existing nursing practices *
Seek out new methods and principles and incorporate them into existing nursing practices proficiency* Seek out new methods and principles and incorporate them into existing nursing practices frequency* Serve on, participate in, and attend Infection Control Committee *
Serve on, participate in, and attend Infection Control Committee proficiency* Serve on, participate in, and attend Infection Control Committee frequency* Understanding of nosocomial infection definitions, chart review, functional understanding of sterilization, disinfections, and sanitation *
Understanding of nosocomial infection definitions, chart review, functional understanding of sterilization, disinfections, and sanitation proficiency* Understanding of nosocomial infection definitions, chart review, functional understanding of sterilization, disinfections, and sanitation frequency* Basic understanding and use of microbiology and epidemiology principles, statistical presentation, outbreak investigation techniques, and computer use *
Basic understanding and use of microbiology and epidemiology principles, statistical presentation, outbreak investigation techniques, and computer use proficiency* Basic understanding and use of microbiology and epidemiology principles, statistical presentation, outbreak investigation techniques, and computer use frequency* Adult teaching techniques, clear oral and written communication skills, project management, and policy management *
Adult teaching techniques, clear oral and written communication skills, project management, and policy management proficiency* Adult teaching techniques, clear oral and written communication skills, project management, and policy management frequency* Working knowledge of OSHA Blood-Borne Pathogen Standards, OSHA Tuberculosis Protection, Title 22, state and federal laws related to communicable diseases, and JCAHO Standards *
Working knowledge of OSHA Blood-Borne Pathogen Standards, OSHA Tuberculosis Protection, Title 22, state and federal laws related to communicable diseases, and JCAHO Standards proficiency* Working knowledge of OSHA Blood-Borne Pathogen Standards, OSHA Tuberculosis Protection, Title 22, state and federal laws related to communicable diseases, and JCAHO Standards frequency*
Surveillance
Proficiency Rating
Frequency Rating
Identify and monitor specified nosocomial infections *
Identify and monitor specified nosocomial infections proficiency* Identify and monitor specified nosocomial infections frequency* Perform / assist with investigations of possible communicable disease exposures among healthcare workers, patients, and / or visitors *
Perform / assist with investigations of possible communicable disease exposures among healthcare workers, patients, and / or visitors proficiency* Perform / assist with investigations of possible communicable disease exposures among healthcare workers, patients, and / or visitors frequency* Collect, monitor, and maintain records and data pertinent to surveillance utilizing Center for Disease Control (CDC) infection criteria, documentation, and investigation techniques *
Collect, monitor, and maintain records and data pertinent to surveillance utilizing Center for Disease Control (CDC) infection criteria, documentation, and investigation techniques proficiency* Collect, monitor, and maintain records and data pertinent to surveillance utilizing Center for Disease Control (CDC) infection criteria, documentation, and investigation techniques frequency* Conduct rounds to nursing units and hospital department for the purpose of monitoring isolation precautions / practices *
Conduct rounds to nursing units and hospital department for the purpose of monitoring isolation precautions / practices proficiency* Conduct rounds to nursing units and hospital department for the purpose of monitoring isolation precautions / practices frequency* Develop and implement a practical system of detecting, evaluating, recording, and reporting infections which originate with facility personnel *
Develop and implement a practical system of detecting, evaluating, recording, and reporting infections which originate with facility personnel proficiency* Develop and implement a practical system of detecting, evaluating, recording, and reporting infections which originate with facility personnel frequency* Ensure that all personnel follow established procedures for the disposal and removal of infected and contaminated materials from the facility *
Ensure that all personnel follow established procedures for the disposal and removal of infected and contaminated materials from the facility proficiency* Ensure that all personnel follow established procedures for the disposal and removal of infected and contaminated materials from the facility frequency* Make rounds of hospital units for the purpose of case definition, monitoring of infection control practices, and other related patient care issues *
Make rounds of hospital units for the purpose of case definition, monitoring of infection control practices, and other related patient care issues proficiency* Make rounds of hospital units for the purpose of case definition, monitoring of infection control practices, and other related patient care issues frequency* Monitor infection control practices and procedures to ensure that all personnel are implementing standard operating procedures for tasks involving exposure to bloody / body fluids *
Monitor infection control practices and procedures to ensure that all personnel are implementing standard operating procedures for tasks involving exposure to bloody / body fluids proficiency* Monitor infection control practices and procedures to ensure that all personnel are implementing standard operating procedures for tasks involving exposure to bloody / body fluids frequency* Monitor for compliance with federal and state laws regarding Infection *
Monitor for compliance with federal and state laws regarding Infection proficiency* Monitor for compliance with federal and state laws regarding Infection frequency* Control issues such as medical wastes, chemicals in the workplace, and infectious disease exposures, and OSHA, CalOsh, and NIOSH standards related to blood-borne pathogens and respiratory pathogens *
Control issues such as medical wastes, chemicals in the workplace, and infectious disease exposures, and OSHA, CalOsh, and NIOSH standards related to blood-borne pathogens and respiratory pathogens proficiency* Control issues such as medical wastes, chemicals in the workplace, and infectious disease exposures, and OSHA, CalOsh, and NIOSH standards related to blood-borne pathogens and respiratory pathogens frequency* Participate in performance improvement projects related to communicable diseases and emerging pathogens within the facility *
Participate in performance improvement projects related to communicable diseases and emerging pathogens within the facility proficiency* Participate in performance improvement projects related to communicable diseases and emerging pathogens within the facility frequency* Perform targeted surveillance and outbreak investigations *
Perform targeted surveillance and outbreak investigations proficiency* Perform targeted surveillance and outbreak investigations frequency* Perform / assist with investigation of clusters or outbreaks of infections or colonization *
Perform / assist with investigation of clusters or outbreaks of infections or colonization proficiency* Perform / assist with investigation of clusters or outbreaks of infections or colonization frequency* Perform / assist with tracing the possible sources of infection or transmission of microorganisms *
Perform / assist with tracing the possible sources of infection or transmission of microorganisms proficiency* Perform / assist with tracing the possible sources of infection or transmission of microorganisms frequency*
Problem Identification
Proficiency Rating
Frequency Rating
Assist in identifying epidemiologically important issues so that appropriate plans for action can be designed, including Surveillance, Outbreak Investigations, and Performance Improvement Projects *
Assist in identifying epidemiologically important issues so that appropriate plans for action can be designed, including Surveillance, Outbreak Investigations, and Performance Improvement Projects proficiency* Assist in identifying epidemiologically important issues so that appropriate plans for action can be designed, including Surveillance, Outbreak Investigations, and Performance Improvement Projects frequency* Identify and report communicable diseases as required by the state and the local health authority, for example, TB, AIDS, and other current public health issues *
Identify and report communicable diseases as required by the state and the local health authority, for example, TB, AIDS, and other current public health issues proficiency* Identify and report communicable diseases as required by the state and the local health authority, for example, TB, AIDS, and other current public health issues frequency* Understand the transmission of infections and assist in the reduction of risk among patients, facility staff, volunteers, students, and visitors *
Understand the transmission of infections and assist in the reduction of risk among patients, facility staff, volunteers, students, and visitors proficiency* Understand the transmission of infections and assist in the reduction of risk among patients, facility staff, volunteers, students, and visitors frequency* DOCUMENTATION
Prepare monthly summaries of all infections, corrective action taken, and the results of the corrective action *
Prepare monthly summaries of all infections, corrective action taken, and the results of the corrective action proficiency* Prepare monthly summaries of all infections, corrective action taken, and the results of the corrective action frequency* Prepare summaries of special investigations of the occurrence of nosocomial and community - acquired infections *
Prepare summaries of special investigations of the occurrence of nosocomial and community - acquired infections proficiency* Prepare summaries of special investigations of the occurrence of nosocomial and community - acquired infections frequency* Provide a report of pertinent findings and recommendations pertaining to nosocomial infections *
Provide a report of pertinent findings and recommendations pertaining to nosocomial infections proficiency* Provide a report of pertinent findings and recommendations pertaining to nosocomial infections frequency* Provide information relative to TB assessment and make recommendations concerning the protocols to follow in isolating TB cases *
Provide information relative to TB assessment and make recommendations concerning the protocols to follow in isolating TB cases proficiency* Provide information relative to TB assessment and make recommendations concerning the protocols to follow in isolating TB cases frequency* Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the facility’s policies and procedures governing accidents and incidents *
Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the facility’s policies and procedures governing accidents and incidents proficiency* Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the facility’s policies and procedures governing accidents and incidents frequency*
Policies And Procedures
Proficiency Rating
Frequency Rating
Develop, maintain, and periodically update infection control precautions and aseptic techniques that successfully correct problem areas *
Develop, maintain, and periodically update infection control precautions and aseptic techniques that successfully correct problem areas proficiency* Develop, maintain, and periodically update infection control precautions and aseptic techniques that successfully correct problem areas frequency* Draft the hospitals Infection Control Plan and annually review, evaluate, and update plan based upon surveillance data findings *
Draft the hospitals Infection Control Plan and annually review, evaluate, and update plan based upon surveillance data findings proficiency* Draft the hospitals Infection Control Plan and annually review, evaluate, and update plan based upon surveillance data findings frequency* Draft, review, and evaluate Infection Control policies / practices associated with infection control *
Draft, review, and evaluate Infection Control policies / practices associated with infection control proficiency* Draft, review, and evaluate Infection Control policies / practices associated with infection control frequency* Ensure the facility is in compliance with current CDC, OSHA, and local regulations concerning infection control and universal precautions *
Ensure the facility is in compliance with current CDC, OSHA, and local regulations concerning infection control and universal precautions proficiency* Ensure the facility is in compliance with current CDC, OSHA, and local regulations concerning infection control and universal precautions frequency* Interpret infection control policies and procedures as necessary *
Interpret infection control policies and procedures as necessary proficiency* Interpret infection control policies and procedures as necessary frequency* Make recommendations utilizing professional guidelines (CDC, APIC, etc.) to comply with regulatory and accrediting agencies, such as federal, state, and local health agencies, and the Joint Commission of Accreditation of Health Care Organizations. Update policies, practices, and the Infection Control Plan to reflect and meet any required changes *
Make recommendations utilizing professional guidelines (CDC, APIC, etc.) to comply with regulatory and accrediting agencies, such as federal, state, and local health agencies, and the Joint Commission of Accreditation of Health Care Organizations. Update policies, practices, and the Infection Control Plan to reflect and meet any required changes proficiency* Make recommendations utilizing professional guidelines (CDC, APIC, etc.) to comply with regulatory and accrediting agencies, such as federal, state, and local health agencies, and the Joint Commission of Accreditation of Health Care Organizations. Update policies, practices, and the Infection Control Plan to reflect and meet any required changes frequency* Participate in development of antibiotic protocols *
Participate in development of antibiotic protocols proficiency* Participate in development of antibiotic protocols frequency*
Coordination
Proficiency Rating
Frequency Rating
Act as department liaison for Infection Control and as consultant for the facility to integrate Infection Control activities *
Act as department liaison for Infection Control and as consultant for the facility to integrate Infection Control activities proficiency* Act as department liaison for Infection Control and as consultant for the facility to integrate Infection Control activities frequency* Assist Housekeeping Services in developing infection control procedures for the routine and terminal cleaning of isolation rooms and areas and equipment cleaning *
Assist Housekeeping Services in developing infection control procedures for the routine and terminal cleaning of isolation rooms and areas and equipment cleaning proficiency* Assist Housekeeping Services in developing infection control procedures for the routine and terminal cleaning of isolation rooms and areas and equipment cleaning frequency* Assist in developing and implementing guidelines for decontamination and sterilization activities *
Assist in developing and implementing guidelines for decontamination and sterilization activities proficiency* Assist in developing and implementing guidelines for decontamination and sterilization activities frequency* Assist in evaluating and implementing recommendations from the Infection Control Committee *
Assist in evaluating and implementing recommendations from the Infection Control Committee proficiency* Assist in evaluating and implementing recommendations from the Infection Control Committee frequency* Assist Laundry Services in developing infection control procedures for the handling of clean and soiled laundry / linen and equipment cleaning *
Assist Laundry Services in developing infection control procedures for the handling of clean and soiled laundry / linen and equipment cleaning proficiency* Assist Laundry Services in developing infection control procedures for the handling of clean and soiled laundry / linen and equipment cleaning frequency* Assist the Discharge Planning Coordinator in developing and implementing discharge plans for patients / clients in isolation or on infection control precautions *
Assist the Discharge Planning Coordinator in developing and implementing discharge plans for patients / clients in isolation or on infection control precautions proficiency* Assist the Discharge Planning Coordinator in developing and implementing discharge plans for patients / clients in isolation or on infection control precautions frequency* Assist the Infection Control Committee in evaluating and revising infection control practices and aseptic techniques to ensure continued sanitation practices are maintained *
Assist the Infection Control Committee in evaluating and revising infection control practices and aseptic techniques to ensure continued sanitation practices are maintained proficiency* Assist the Infection Control Committee in evaluating and revising infection control practices and aseptic techniques to ensure continued sanitation practices are maintained frequency* Assist in planning with other departments and personnel to reduce the risk of disease transmission and improve infection control practices *
Assist in planning with other departments and personnel to reduce the risk of disease transmission and improve infection control practices proficiency* Assist in planning with other departments and personnel to reduce the risk of disease transmission and improve infection control practices frequency*
Education
Proficiency Rating
Frequency Rating
Assist in developing OSHA and CDC in-service training programs for hazard communication, TB management, and blood-borne pathogens standards *
Assist in developing OSHA and CDC in-service training programs for hazard communication, TB management, and blood-borne pathogens standards proficiency* Assist in developing OSHA and CDC in-service training programs for hazard communication, TB management, and blood-borne pathogens standards frequency* Assist the personnel director in developing and implementing and employee health services program, including individual counseling as outlined in infection control and the employee health program *
Assist the personnel director in developing and implementing and employee health services program, including individual counseling as outlined in infection control and the employee health program proficiency* Assist the personnel director in developing and implementing and employee health services program, including individual counseling as outlined in infection control and the employee health program frequency* Develop a training program for all personnel required to perform tasks involving exposure to blood / body fluids *
Develop a training program for all personnel required to perform tasks involving exposure to blood / body fluids proficiency* Develop a training program for all personnel required to perform tasks involving exposure to blood / body fluids frequency* Develop, implement, and conduct in-service training programs relative to infection control *
Develop, implement, and conduct in-service training programs relative to infection control proficiency* Develop, implement, and conduct in-service training programs relative to infection control frequency* Orient new employees to the importance of infection control policies and procedures, personal hygiene, and handwashing techniques, as well as the employees responsibility to follow established procedures for tasks involving exposure to blood / body fluids *
Orient new employees to the importance of infection control policies and procedures, personal hygiene, and handwashing techniques, as well as the employees responsibility to follow established procedures for tasks involving exposure to blood / body fluids proficiency* Orient new employees to the importance of infection control policies and procedures, personal hygiene, and handwashing techniques, as well as the employees responsibility to follow established procedures for tasks involving exposure to blood / body fluids frequency* Provide personnel with information concerning the facility’s policies governing hepatitis B vaccinations *
Provide personnel with information concerning the facility’s policies governing hepatitis B vaccinations proficiency* Provide personnel with information concerning the facility’s policies governing hepatitis B vaccinations frequency*
Patient Care
Proficiency Rating
Frequency Rating
Assist in the development, implementation, and maintenance of a plan of care for patients / clients in isolation or on infection control precautions that identifies the problems / needs of the patients / clients *
Assist in the development, implementation, and maintenance of a plan of care for patients / clients in isolation or on infection control precautions that identifies the problems / needs of the patients / clients proficiency* Assist in the development, implementation, and maintenance of a plan of care for patients / clients in isolation or on infection control precautions that identifies the problems / needs of the patients / clients frequency* Ensure that patients / clients with known communicable or infectious diseases are placed in isolation or on infection control precautions to include universal precautions *
Ensure that patients / clients with known communicable or infectious diseases are placed in isolation or on infection control precautions to include universal precautions proficiency* Ensure that patients / clients with known communicable or infectious diseases are placed in isolation or on infection control precautions to include universal precautions frequency* Interview patients / clients or family members and explain isolation and universal precautions as necessary *
Interview patients / clients or family members and explain isolation and universal precautions as necessary proficiency* Interview patients / clients or family members and explain isolation and universal precautions as necessary frequency* Review and analyze infectious disease laboratory reports and consult with Nursing Services in developing a care plan, ensuring that aseptic techniques are implemented *
Review and analyze infectious disease laboratory reports and consult with Nursing Services in developing a care plan, ensuring that aseptic techniques are implemented proficiency* Review and analyze infectious disease laboratory reports and consult with Nursing Services in developing a care plan, ensuring that aseptic techniques are implemented frequency* Review nurses notes of patients / clients in / on isolation precautions to ensure that they are informative and descriptive of the nursing care being provided and that they reflect the patients and / or clients response to the care *
Review nurses notes of patients / clients in / on isolation precautions to ensure that they are informative and descriptive of the nursing care being provided and that they reflect the patients and / or clients response to the care proficiency* Review nurses notes of patients / clients in / on isolation precautions to ensure that they are informative and descriptive of the nursing care being provided and that they reflect the patients and / or clients response to the care frequency* Visit isolated patients / clients as necessary to ensure that established isolation precautions and aseptic techniques are followed *
Visit isolated patients / clients as necessary to ensure that established isolation precautions and aseptic techniques are followed proficiency* Visit isolated patients / clients as necessary to ensure that established isolation precautions and aseptic techniques are followed frequency*
Medications / Therapeutic Interventions
Proficiency Rating
Frequency Rating
MEDICATION ADMINISTRATION
Administer IM and SQ *
Administer IM and SQ proficiency* Administer IM and SQ frequency* Administer PO *
Administer PO proficiency* Administer PO frequency* Administer IV *
Administer IV proficiency* Administer IV frequency* Needleless Systems *
Needleless Systems proficiency* Needleless Systems frequency* THERAPEUTIC INTERVENTIONS
Antibiotic Usage *
Antibiotic Usage proficiency* Antibiotic Usage frequency* Antimicrobial Protocols *
Antimicrobial Protocols proficiency* Antimicrobial Protocols frequency* Central Line Bundles *
Central Line Bundles proficiency* Central Line Bundles frequency*
Procedures / Equipment
Proficiency Rating
Frequency Rating
PERFORM
Isolation *
Isolation proficiency* Isolation frequency* Collect Data *
Collect Data proficiency* Collect Data frequency* Statistical Collation *
Statistical Collation proficiency* Statistical Collation frequency* Educate Staff *
Educate Staff proficiency* Educate Staff frequency* Develop and Make Presentations *
Develop and Make Presentations proficiency* Develop and Make Presentations frequency* Write Policies *
Write Policies proficiency* Write Policies frequency* Develop Protocols *
Develop Protocols proficiency* Develop Protocols frequency* Conduct Continuous Surveillance *
Conduct Continuous Surveillance proficiency* Conduct Continuous Surveillance frequency* Donning PPE *
Donning PPE proficiency* Donning PPE frequency* Doffing PPE *
Doffing PPE proficiency* Doffing PPE frequency* SPECIMEN COLLECTION
Butterfly Stick *
Butterfly Stick proficiency* Butterfly Stick frequency* Central Line Draw *
Central Line Draw proficiency* Central Line Draw frequency* Clean Catch Urine *
Clean Catch Urine proficiency* Clean Catch Urine frequency* Cultures - Blood *
Cultures - Blood proficiency* Cultures - Blood frequency* Urine Dipstick *
Urine Dipstick proficiency* Urine Dipstick frequency* Finger Stick *
Finger Stick proficiency* Finger Stick frequency* Stool *
Stool proficiency* Stool frequency* Sputum *
Sputum proficiency* Sputum frequency* Sterile Urine *
Sterile Urine proficiency* Sterile Urine frequency* Certify your information* I certify that I have provided true and accurate information about my skills and experience to the best of my ability
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