POSITION: Licensed Practical Nurse
Please check all that apply
__ Less than High School __ High School or GED __ Technical Training __ Bachelor Degree in
__ RN __ Associate Degree __Post Graduate Degree _X__ LPN license
__None __ Previous experience required _X_ Previous experience preferred (Acute care all age groups) __ Other
_X_ Organizational _X_ Customer Relations _X_ ACLS Certified preferred _X_ CPR/BLS Certified __X_PALS preferred ___NRP _X_ Math _X_ Grammar/ Spelling
__ Typing _______ wpm __ Transcription _X_ Read, Write, Speak, understand English _X__ TN State Licensure/ Certificate/ Registration
__Professional Certification ( LCSW, AART) _X_ Follow written and oral direction _X__ IV Therapy Certified
_X_ Computer Training (Excel, Microsoft Word, Meditech) ___Other ________________________________________________________
Physical demands = On the job time is spent in the following physical activities. Show the amount of time by checking the appropriate boxes.
Up to 1/3
1/3 to 1/2
½ and more
__None Check all that apply.
_X_ Exposure to toxic/caustic/ chemical detergents
_X_ Exposure to extreme conditions, hot/ cold
_X_ Exposure to dust/ fumes/ airborne particles
Talk and hear
_X_ Exposure to moving mechanical parts
_X_ Exposure to potential electrical shock
Climb, Stoop, Kneel, Crouch, or Crawl
_X_ Exposure to x-ray/ electromagnetic energy
Reach with hands and arms
__ Exposure to high pitched/ very loud noise
Taste or smell
_X_ Exposure to communicable diseases/ blood/ body fluids
Perform repetitive tasks
_X_ Exposure to potential muscle- skeletal injuries
Hand/ eye coordination
OSHA EXPOSURE CATEGORY: I
__ No special requirements
_X_ Close vision ( clear vision at 20 inches or less)
_X_ Distance vision ( ability to identify and distinguish colors)
_X_ Peripheral vision ( ability to observe an area that can be seen up and down or to the left and right while eyes are fixed on a given
_X_ Depth perception ( three- dimensional vision, ability to judge distances and spatial relationships)
_X_ Ability to adjust focus ( ability to adjust the eye to bring an object into sharp focus)
__ Sedentary work: prolonged periods of sitting and exert up to 10 lbs. of force occasionally.
__ Light work: exert up to 20 lbs. of force occasionally, and or up to 10 lbs. force frequently.
_X_ Medium work: exert up to 50 lbs. force occasionally, and/or up to 20 lbs. force frequently, and/or up to 10 lbs. force frequently.
__ Very heavy work: exert over 100 lbs. force occasionally, and/or over 50 lbs. frequently, and/or over 20 lbs. constantly.
_X_ Make decisions under pressure
_X_ Work alone
_X_ Frequent involvement with patients, physicians, hospital personnel, family members during periods of stress
_X_ Manage anger/ fear/ hostility/ violence of others appropriately
_X_ Handle multiple priorities
_X_ Work in areas that are confined and/or crowded
_X_ All Age groups __ Neonate/ Infant (birth – 12 months) __ Adolescent (13-18 yr.) __ Geriatric (65 and older)
__ Pediatric (12months- 12 yr.) __ Adult (19-64 yr.) __ N/A ( does not provide routine direct patient care services)