Feeding Tube Competency Checklist Form
Evaluate caregiver or clinician proficiency in feeding tube care and administration.
Full Name
*
First Name
Last Name
Role
*
Please Select
Registered Nurse
Licensed Practical Nurse
Certified Nursing Assistant
Caregiver
Other
Demonstrates proper hand hygiene before and after feeding tube procedures.
*
Competent
Needs Improvement
Not Observed
Select the correct steps for preparing feeding equipment.
*
Check expiration date of formula
Wash hands thoroughly
Label feeding container
Warm formula in microwave
Other
Ability to verify correct tube placement before administration
*
1
2
3
4
5
Feeds are administered at the correct rate and method as per protocol.
*
Always
Sometimes
Never
Recognizes and manages common complications (e.g., blockage, aspiration, infection).
*
Rows
Confident
Needs Practice
Not Observed
Blockage
1
2
3
Aspiration
4
5
6
Infection
7
8
9
Documents feeding procedure and outcomes accurately.
*
Not at all
1
2
3
4
Always
5
1 is Not at all, 5 is Always
Demonstrates safe disposal of feeding equipment and waste.
*
Competent
Needs Improvement
Not Observed
Comments or specific observations
Submit Assessment
Should be Empty: