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Home Health Aide Skills Checklist Form Template

Streamline Your Hiring Process with Our Skills Checklist

Finding qualified home health aides can be challenging, and ensuring they possess the necessary skills is crucial for quality care. This template helps you effectively evaluate your candidates' competencies, providing a clear framework for assessing their skills. With this checklist, you can streamline the hiring process, maintain consistent standards, and enhance patient safety-all while saving time and reducing administrative tasks. Experience peace of mind as you onboard staff who are ready for their roles. Explore the live template here.

Full name
Email address
Mobile phone number
Earliest start date
Are you legally authorized to work in your country of residence?
Yes
No
Do you have reliable transportation for client visits?
Yes
No
Languages you can provide care in
Please Specify:
Shift availability
Weekdays
Weekends
Day shifts
Evening shifts
Overnight shifts
Live-in (24-hour)
On-call
Holidays
Maximum hours per week you prefer
Up to 10
11-20
21-30
31-40
Over 40
Do you currently hold a Home Health Aide (HHA) certification?
Yes
No
HHA certification state or issuing authority
CPR/First Aid certified
Yes
No
Years of professional caregiving/HHA experience
None
Less than 1 year
1-2 years
3-5 years
6-10 years
More than 10 years
Care settings you have experience in
Private home
Assisted living
Skilled nursing facility
Home health agency
Hospital
Hospice
Memory care
Other
Please Specify:
Bathing and showering assistance
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Bed bath
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Dressing and grooming
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Oral hygiene and denture care
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Toileting assistance (commode/bedpan/urinal)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Perineal care and incontinence care
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Skin care and pressure area prevention (basic)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Bed making (occupied and unoccupied)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Measuring and recording intake and output (I&O)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Transfers (bed to chair/wheelchair) using proper body mechanics
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Use of gait belt for transfers and ambulation
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Ambulation assistance (with or without assistive devices)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Positioning and turning in bed/chair
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Range of motion exercises (active/passive as directed)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Fall prevention and home safety checks
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Meal planning and basic meal preparation
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Safe food handling and kitchen safety
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Feeding assistance (cueing, set-up, safe swallow awareness)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Special diet adherence (e.g., diabetic, low sodium) as directed
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Light housekeeping and laundry related to client care
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Errands and grocery shopping as allowed
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Vital signs: temperature, pulse, respirations (as directed)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Blood pressure measurement (manual or automated) as allowed
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Blood glucose monitoring (with approved device) as allowed
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Oxygen safety (no adjustment of flow unless directed)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Medication reminders and adherence support (no administration)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Recognizing and reporting changes in condition promptly
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Hand hygiene (soap and water, hand sanitizer) best practices
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Standard and contact precautions (gloves, masks, gowns) use
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Cleaning and disinfection of client care areas and equipment
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Dementia/Alzheimer's care techniques (cueing, redirection, validation)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
De-escalation and managing agitation safely
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Companionship and engagement in meaningful activities
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Read and follow plan of care and task lists accurately
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Complete shift notes and documentation clearly and on time
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Communicate observations to supervising nurse/agency promptly
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Comfort care and positioning for hospice/palliative clients (as directed)
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
Respect for cultural, spiritual, and family preferences
No experience
Needs training
Competent with supervision
Competent independently
Can teach others
Not applicable
I attest that the information provided is true and complete to the best of my knowledge.
Yes
No
Typed signature (full legal name)
Signature date
I consent to the verification of my credentials and experience, including contacting references.
Yes
No
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Paper art illustration representing a home health aide skills checklist for a form template.

When to use this form

Use this skills checklist when you screen applicants, onboard new aides, or run annual competency reviews. It helps you verify hands-on abilities (bathing, transfers, vitals, dementia care) and match staff to each care plan. For private-duty agencies, pair it with the Home care inquiry form to capture a family's needs and note any restrictions. After placement, the Home care timesheet form keeps hours and visits aligned with the skills approved here. Teams that float aides between home and facility settings can adapt the checklist to target training and make safe assignments.

Must Ask Home Health Aide Skills Checklist Questions

  1. Which personal care tasks can you perform independently, and which require supervision?

    This clarifies scope so you assign cases that fit current competence and comply with policy. It also flags training needed before the aide works alone in the home.

  2. What is your experience with safe transfers and mobility equipment (gait belt, walker, wheelchair, Hoyer lift)?

    Transfer skill drives fall risk and staffing decisions for two-person assists. Documenting tools used helps you match homes with required equipment and plan coaching.

  3. Can you take, record, and report vital signs, and when do you escalate changes?

    Clear thresholds for escalation protect clients and reduce avoidable ER visits. You also standardize how you document readings and notify supervisors.

  4. What training have you completed in infection control, and how do you apply standard precautions in the home?

    This verifies PPE, hand hygiene, and cleaning practices that keep clients and staff safe. Specific examples show real-world readiness, not just classroom knowledge.

  5. Do you have experience with end-of-life care, including comfort measures and family communication?

    Some clients receive hospice services; knowing this helps you assign cases and plan orientation. If a case includes hospice paperwork, such as a Hospice certification of terminal illness form, you can coordinate roles and expectations.

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