Nursing Assistant Skill Mapping Survey
Help us assess your competencies, training, and experience as a nursing assistant to better support your professional development.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current Facility or Department
*
Years of Experience as a Nursing Assistant
*
Nursing Certifications Held (select all that apply)
*
Certified Nursing Assistant (CNA)
Basic Life Support (BLS)
CPR Certification
First Aid Certification
Other
Please rate your proficiency in the following nursing assistant skills:
*
Rows
No Experience
Beginner
Competent
Advanced
Expert
Patient Hygiene and Personal Care
1
2
3
4
5
Vital Signs Monitoring
6
7
8
9
10
Mobility Assistance (Transfers, Ambulation)
11
12
13
14
15
Feeding Assistance
16
17
18
19
20
Infection Control Procedures
21
22
23
24
25
Documentation and Reporting
26
27
28
29
30
Bed Making and Room Preparation
31
32
33
34
35
Are you comfortable using the following medical equipment? (Select all that apply)
Blood Pressure Monitor
Glucometer
Wheelchair and Transfer Devices
Oxygen Equipment
Other
Which shifts are you available for?
Day
Evening
Night
Weekends
Please indicate your preferred areas of work:
Long-term Care
Acute Care
Rehabilitation
Home Health
Other
How confident do you feel in your current role as a nursing assistant?
*
1
2
3
4
5
Please list any additional skills, languages spoken, or training you would like to share.
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