Competency evaluation tools are position-specific. The tool that is attached hereto must be used for Home Health Aides only.

HHA Competency Evaluation 1/18

HOME HEALTH AIDE COMPETENCY EVALUATION

Aides determined competent based on the evaluation criteria below meet federally mandated basic competency requirements. Such aides are not deemed HHA’s unless trained in a NYS approved Training Program or successfully completing a NYS approved equivalency examination. The competency evaluation must be performed by a registered nurse.

Page 1 of 3

Employee Name: _____________________________________________________________ SS#: _______________________________________________ RN Evaluator: _____________________________________________________________ License #: _________________________________________ (Must be completed by the Registered Nurse who observes the following tasks performed by the HHA)

Competency: Method: Satisfactory S Written Exam E Unsatisfactory U Interview I Training Program T On-The- Job Training J In-Service S Observation O

Required Skill Competency Method Date Competency Post-Remediation

Method Date RN Initials

Remarks

1 Bed Bath Sponge Tub Shower Comments:

2 Shampoo Bed Sink Tub Comments:

3 Nail Care Fingers Toes Comments:

4

Skin Care Lotion Massage Comments:

5

Oral Hygiene Comments:

Skills must be performed on a patient or pseudo-patient, not a mannequin.

HHA Competency Evaluation 1/18

HOME HEALTH AIDE COMPETENCY EVALUATION

Aides determined competent based on the evaluation criteria below meet federally mandated basic competency requirements. Such aides are not deemed HHA’s unless trained in a NYS approved Training Program or successfully completing a NYS approved equivalency examination. The competency evaluation must be performed by a registered nurse.

Page 2 of 3

Competency: Method: Satisfactory S Written Exam E Unsatisfactory U Interview I

Training Program T On-The- Job Training J In-Service S Observation O

Home Health Aide Name: ________________________________________________________________________

Required Skill Competency Method Date Competency Post-Remediation

Method Date RN Initials

Remarks

6 Toileting and Elimination Bed Pan Urinal CommodeComments:

7 Transfer Techniques Comments: Hoyer Lift Included

8 Positioning Comments:

9 Range of Motion Comments:

10 Ambulation Alone With Aide With CrutchesComments:

11 Temperature, Pulse, Respirations Read RecordedComments:

12 Blood Pressure Read RecordedComments:

HHA Competency Evaluation 1/18

HOME HEALTH AIDE COMPETENCY EVALUATION

Aides determined competent based on the evaluation criteria below meet federally mandated basic competency requirements. Such aides are not deemed HHA’s unless trained in a NYS approved Training Program or successfully completing a NYS approved equivalency examination. The competency evaluation must be performed by a registered nurse.

Page 3 of 3

Competency: Method: Satisfactory S Written Exam E Unsatisfactory U Interview I Training Program T On-The- Job Training J In-Service S Observation O Home Health Aide Name: ________________________________________________________________________

Required Skill Competency Method Date Competency Post-Remediation

Method Date RN Initials

Remarks

13

Follows Procedure for Infection Control Comments:

14 Understands Elements of: Managed Diet Fluid Intake Comments:

15 Understands Physical, Emotional and Developmental Needs of Patients Comments:

16 Maintains Records of Patient Activities Performed Comments:

17

Reports Changes in Patient Condition and Environment Comments:

18 Understands Emergency Procedures Patient's Rights Confidentiality Comments:

Skills must be performed on a patient or pseudo-patient, not a mannequin.

RN Evaluator Signature: _________________________________________________________

HHA Competency Evaluation 1/18