Skills Practice Procedure Checklist - Washington Care Academy

For Complete Skills Practice Procedure Checklist for Home Care Aides Click the Link below

https://www.dshs.wa.gov/sites/default/files/forms/pdf/16-245.pdf

Skills Practice Procedure Checklist for Home Care Aides. DSHS Approved

Verification of HCS On The Job Skills Practice Training Provided by Facility Instructor(s) in an AFH, ALF, or ESF

This page must be sent to the DSHS Training Unit for each Home Care Aide candidate who has completed On-The-Job skills training at your facility.

Email, this page only to the TrainingApprovalITPA@dshs.wa.gov inbox. Enter “Facility On-The-Job Training” as the subject line.

Name of Student(Required)

First Last

Has successfully demonstrated, while working with a client, in the presence of an approved DSHS facility instructor, all critical steps required for personal care task included on this procedure checklist.

FACILITY NAME(Required)

FACILITY TRAINING NUMBER

INSTRUCTOR'S SIGNATURE

PRINT INSTRUCTOR'S NAME(Required)

INSTRUCTOR'S TRAINING CODE NUMBER

STUDENT'S SIGNATURE

PRINT STUDENT'S NAME(Required)

DATE OF COMPLETION(Required)

Please Note: All skills tasks must be taught by an approved facility instructor and demonstrated by the Home Care Aide worker/employee. When needed, if no client is available or no client agrees to participate in a particular skills training procedure, home care aide skills performance may be evaluated by using a mannequin or training partner