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House Manager/Supervisor
House Manager/Supervisor
Name
*
Full Name
Date
MM slash DD slash YYYY
Self-Assessment Rating Scale
No Experience
Theory or observation only during the past 12 months
Limited Experience
Performed less than 12 times within the past 12 months and may need a review
Experienced
Performed at least once per month within the past 12 months and may need minimal assistance
Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient
Age of Patients Cared For
No Experience
Limited Experience
Experienced
Highly Skilled
Newborn/Neonate (Birth - 30 Days)
Infant (31 days - 12 months)
Toddler/Preschool (13 months - 5 years)
School Age Child/Adolescent (6 years - 18 years)
Young Adults/Middle Adults (19 years - 64 years)
Older Adults (65+ years)
General Skills
Certifications
Check all that apply.
Allscripts
Care 360
Cerner
eClinicalWorks
EPIC
MACLAB
McKesson
MediTech
PACS
Soarian
N/A
IV Pumps
No Experience
Limited Experience
Experienced
Highly Skilled
Alaris
Alibaba
Bard
Baxter
Braun
CADD
IVAC
Zynomed
N/A
General Skills
No Experience
Limited Experience
Experienced
Highly Skilled
Universal Precautions
Working with patients in isolation
Working with patients in restraints
Patient/Family Teaching
Patient Identification
Specialty Beds
End of life care/Palliative care
Knowledge of "Do Not Use" abbreviations
Charge/supervisor experience
Knowledge of current Joint Commission National Patient Safety Goals
Knowledge familiarity with HCAHPS scores
Environments
No Experience
Limited Experience
Experienced
Highly Skilled
Acute care/Hospital
Durable medical equipment (DME)
SNF/Long term care
Home health
Hospice
Outpatient
Physician Office
Management
No Experience
Limited Experience
Experienced
Highly Skilled
Understanding of health care economics and health care as it applies to delivery of patient care
Concepts of capital budgeting
Department/unit budgeting
Recruitment techniques
Interviewing techniques
Labor laws pertaining to hiring
Orientation of new employees
Knowledge of quality improvement/performance improvement tools
Patient safety
Workplace safety
Promotion of interdepartmental communcation
Performance management
Staff development
Coaching and mentoring
Project management
Business development
Developing strategic plans
Developing operational plans
Cultural competence
Personal growth and development
Ethical behavior and practice
Professional association involvement
Conflict management
Team dynamics
Meditation/coaching
JCAHO standards
OSHA standards
Risk management/service utilization
Local Department of Health
State Department of Health
Sitter services
Signature
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