Group Activities - COVID-19

All Staff Group Activities Competency Checklist

All Staff Group Activities Competency Checklist

 

Name:______________________________ Title: ___________________________ Hire Date:_______________

 

Skill Area

Evaluation

(Check One)

Method of Evaluation

(Check One)

D = Skills Demonstration

O = Performance Observation

W = Written Test

V = Verbal Test

Verification

(Initials/Date)

 

Competency

Demonstrated/

Meets

Standards

Needs Additional Training

 

D

O

W

V

 

All Staff

 

Staff verbalize the protocol to follow when assisting a resident to do an activity in their room

 

 

 

 

 

 

 

 

Staff monitors and verbalizes how to coach residents in proper use of facial coverings

 

 

 

 

 

 

 

 

Staff monitors and verbalizes how to coach residents in proper completion of hand hygiene

 

 

 

 

 

 

 

 

Staff verbalizes understanding of when group activities will not be performed

 

 

 

 

 

 

 

 

Staff verbalizes residents who would be able to participate in group activities

 

 

 

 

 

 

 

 

Staff verbalizes understanding of small group programming and ways to promote attendance

 

 

 

 

 

 

 

 

Staff knows where the designated small group activity locations are

 

 

 

 

 

 

 

 

Staff assist residents to participate in small groups

 

 

 

 

 

 

 

 

Staff are observed assisting residents to pursue activities of interest

 

 

 

 

 

 

 

 

Proper cleaning and disinfection processes are followed as needed

 

 

 

 

 

 

 

 

Staff document resident activity participation and engagement

 

 

 

 

 

 

 

 

Staff demonstrate PPE application and removal and purpose for type of precaution needed

 

 

 

 

 

 

 

 

Staff know how, when and to whom personal and resident symptoms of COVID-19 are reported

 

 

 

 

 

 

 

 

 

Other (Describe)

 

 

 

 

 

 

 

 

 

 

Other (Describe)

 

 

 

 

 

 

 

 

 

 

 

 

 

*I certify that I have received orientation in the above-mentioned areas.

 

       
   

*Employee:

 

 

___________  _______________________________________     ____________

Initials            Signature                                                                                Date

 

 
 
 

Evaluator/Trainer:

 

 

___________  _______________________________________     ____________

Initials            Signature                                                                                Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(PLACE IN EMPLOYMENT FILE)

References:

 

Centers for Disease Control and Prevention. “Using Personal Protective Equipment (PPE). Updated Aug. 19, 2020: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html