RN Occupational and Employee Health

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale

(PROFICIENCY)
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
(FREQUENCY)
1 = Never performed observed only
2 = Less than 6 times per year
3 = 1-2 times per month
4 = Daily or Weekly
PROFICIENCY / FREQUENCY
PROFICIENCY
FREQUENCY
Skill Level
1
2
3
4
1
2
3
4
TRAUMA
Minor Trauma
Major Trauma
MAST Suit
BURNS
First Degree
Second Degree
Third Degree
Electrocution
Hazardous Materials Exposure
LACERATIONS
Assessment
Cleansing
Steri-Strips
Dressing
SPRAIN/STRAIN
Assessment
Carpal Tunnel
Tendonitis
Epicondylitis
PHYSICALS
Safety
Return to Work
Respirator
Vital Signs
Height/Weight
Blood Draw
Medical Referral Form
Medical Certification Form
Medical History Questionnaire
Potassium Iodine Assessment
RESTRICTIONS
Temporary Restrictions
Permanent Restrictions
Pulmonary Function
Audiometry
Vision Testing
X-ray
Urine Testing
Drug Testing
Breathalyzer
IMMUNIZATIONS
Havrix (Hepatitis A)
Influenza Vaccine
Meningitis Vaccine
Tetanus & Diphtheria
Oral Typhoid Vaccine
Polio Vaccine
Hepatitis B Vaccine
Japanese Encephalitis B
Rabies Vaccine
Typhim (Injectable Type)
Yellow Fever Vaccine
Age Specific Criteria
Newborn/Neonate (birth-30 days)
Infant (30 days - 1 year)
Toddler (1-3 years)
Preschooler (3-5 years)
School Age Children (5-12 years)
Adolescents (12-18 years)
Young Adults (18-39 years)
Middle Adults (39-64 years)
Older Adults (64+)