Healthcare Competency Skills/Evaluation (Page 1 of 5)
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1 (Page 1 of 5) COMPETENCY SKILLS 1 of 5 1 = Cannot Perform Skills Independently EVS Tech 2 = Requires Some Assistance to Perform Skills EVS OR Tech 3 = Can Perform Independently EVS Floor Tech NA = Not Applicable EVS Supervisor 1. What is the procedure for hand washing/hygiene? 2. What are Standard Precautions? 3. How do you protect yourself from blood/body fluid exposure? 4. What procedure do you follow if a patient asks for your assistance? 5. What procedure do you follow for a needlestick? 6. What should you do if you are cleaning a patient's room and a physician comes in to see the patient? 7. What protocol do you follow if you notice a suspicious person or activities? 8. What procedure do you follow if you find a piece of jewelry while cleaning? 9. What do you do if you miss a punch in the computerized punch time system? 10. What personal protective equipment do you wear when cleaning an isolation room? 11. What procedure do you follow for infectious waste? 12. Where would you find out how to clean up an ammonia spill? 13. How is waste transported to the designated storage areas? 14. What items are contained in the Spill Kit? 15. What procedure do you follow for a major spill? Minor spill? 16. What is the dress code for the Surgical Department? 17. What is the procedure for damp mopping? Dust mopping? 18. What procedure do you follow to clean a bed after a patient has been discharged? 19. What is the grievance process and where would you find it in writing? 20. What changes would like to see in the department/facility? 21. Demonstrates competency in the knowledge of the delivery of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors. JANI-KING INTERNATIONAL, INC., 2009 EV
2 2 of 5 (Page 2 of 5) 22. Demonstrates the knowledge of proper identification and reporting of medical/health care errors. Protects the patient in the event of a medical/health care error resolution. 23. Environmental Services - Able to describe, demonstrate thorough knowledge of: a. Cleaning and disinfecting patient and non-patient areas b. Removing regular and medical waste c. Clean linen distribution and soiled linen pick-ups d. Emergency housekeeping services e. Monitoring the interior of the hospital for areas or items needing repair and reporting these items to the appropriate departments for repair f. Cleaning supplies and chemicals, correct mixing ratios, all containers labeled g. Proper body mechanics 24. Demonstrates/provides thorough knowledge of cleaning procedures for: a. Walls b. Floors, stripping, sealing, buffing c. Carpets d. Windows and draperies e. Beds f. Furniture g. Waste containers h. Bathrooms i. Equipment j. Light fixtures k. Stairs l. Non-patient areas, i.e., lobby, waiting room m. Patient care units and departments n. Special Care Patient Departments: JANI-KING INTERNATIONAL, INC., 2009 EV
3 (Page 3 of 5) COMPETENCY SKILLS 3 of 5 (1) Surgery (2) Labor and Delivery 24. n. (3) Emergency Department (4) Critical Care Units (5) Central Service (6) Others 25. Demonstrates/provides thorough knowledge of: a. Cleaning and daily stocking of cleaning carts b. Cleaning and daily stocking of linen carts c. Cleaning of waste disposal carts and dirty linen carts 26. Demonstrates/provides thorough knowledge of cleaning equipment, use and maintenance: a. Vacuum cleaner and attachments b. Carpet extraction machine c. Fan dryers d. Mop bucket with wringer 27. Facility Environment - Able to locate and/or demonstrate knowledge of: a. Facility directory b. Fire Equipment (1) Alarms (2) Extinguishers (3) Exit doors (4) Oxygen valves and shutoffs (5) Emergency (red) outlets 28. Department Resources - Able to locate and demonstrate the use of: a. Environmental Services Policy and Procedure Manual b. Hospital Policy and Procedure Manual JANI-KING INTERNATIONAL, INC., 2009 EV
4 4 of 5 (Page 4 of 5) c. Infection Control Manual d. Material Safety Data Sheets (MSDS) Manual 28. e. Fire/Emergency Management Manual f. Department Specific Reference Materials g. PI Documentation h. Others 29. Department Routines - Abel to describe, locate and/or demonstrate knowledge of: a. Communication System: (1) Bulletin board (2) Logbooks (3) Meeting minutes (4) Ordering supplies b. Cultural Factors: (1) Religion (2) Food preferences (3) Family/community relationships (4) Healthcare attitudes/understanding (5) Trust/privacy needs (6) Socioeconomic environment Franchise Owners must keep a file on all employees working in healthcare facilities. Employee files must be kept for a minimum of five years AFTER Employee terminates. Date signed must be completed for each entry. This checklist must accompany All test in order to become certified. JANI-KING INTERNATIONAL, INC., 2009 EV
5 5 of 5 (Page 5 of 5) Franchisee Signature I affirm that my employee has completed all Healthcare Requirements and completed both the classroom and hands on training. Employee Signature - I understand and have completed all healthcare requirements to perform my job. Instructor Signature I affirm that all Healthcare HR requirements, Classroom Training, and Hands on Training have been completed by this applicant. Regional Director I affirm that all required Drug Screens, Back Ground Checks, Hep B, and TB Screens have been completed prior to sending this HR Checklist to corporate. JANI-KING INTERNATIONAL, INC., 2009 EV
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