Dietary Aide in Health Care Facilities Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information This field is hidden when viewing the formOverall ScoreName(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) This field is hidden when viewing the formDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyIntroduction to Dietary AidePractice within the job description of your employer.(Required) 1 2 3 4 Follow the chain of command.(Required) 1 2 3 4 Explain the importance of following facility policies and procedures.(Required) 1 2 3 4 Identify consequences of failure to follow facility policies and procedures.(Required) 1 2 3 4 Exhibit hygiene and clothing for a dietary aid.(Required) 1 2 3 4 Interpersonal SkillsProvide effective customer service.(Required) 1 2 3 4 Practice common courtesy for better customer relations.(Required) 1 2 3 4 Maintain client confidentiality.(Required) 1 2 3 4 Infection Control and SafetyMaintain safe work environment.(Required) 1 2 3 4 Clean up spills according to facility policy.(Required) 1 2 3 4 Read and follow MSDS guidelines.(Required) 1 2 3 4 Use cleaning chemicals according to label directions.(Required) 1 2 3 4 Mix chemicals according to label directions.(Required) 1 2 3 4 Label secondary chemical containers.(Required) 1 2 3 4 Wear appropriate PPE when using/handling chemicals.(Required) 1 2 3 4 Use safety precautions when handling chemicals.(Required) 1 2 3 4 Dispose of chemicals according to facility policy.(Required) 1 2 3 4 Respond appropriately to emergency situations.(Required) 1 2 3 4 Locate and read the policies/procedures for emergencies.(Required) 1 2 3 4 Wear PPE that is appropriate for the situation and as determined by your health care facility.(Required) 1 2 3 4 Wash hands as needed to prevent cross contamination.(Required) 1 2 3 4 Nutrition, Diet, and DiseaseRecord telephone diet order.(Required) 1 2 3 4 Measure serving sizes accurately.(Required) 1 2 3 4 Estimate fluid intake.(Required) 1 2 3 4 Estimate food intake.(Required) 1 2 3 4 Record food and fluid intake according to facility policy.(Required) 1 2 3 4 Food Handling and PreparationMonitor and record temperatures of equipment.(Required) 1 2 3 4 Check and follow daily work assignments.(Required) 1 2 3 4 Receive and store food products.(Required) 1 2 3 4 Monitor and report inventory levels.(Required) 1 2 3 4 Prepare beverages.(Required) 1 2 3 4 Prepare condiment packages.(Required) 1 2 3 4 Sack bread.(Required) 1 2 3 4 Sack or wrap silverware.(Required) 1 2 3 4 Pour beverages.(Required) 1 2 3 4 Assist cook as directed(Required) 1 2 3 4 Hold prepared foods during serving.(Required) 1 2 3 4 Assemble food trays according to diet orders.(Required) 1 2 3 4 Cool and store leftovers properly.(Required) 1 2 3 4 Prepare supplemental feedings and snacks according to diet orders.(Required) 1 2 3 4 Load the food carts accurately according to facility procedure.(Required) 1 2 3 4 Deliver correct tray to the right person.(Required) 1 2 3 4 Respect client rights.(Required) 1 2 3 4 Clean-up ProceduresReport items needing maintenance or replacement.(Required) 1 2 3 4 Clean and sanitize food preparation surfaces as needed.(Required) 1 2 3 4 Clean and sanitize equipment as needed.(Required) 1 2 3 4 Pick up food trays.(Required) 1 2 3 4 Break down food trays.(Required) 1 2 3 4 Soak the silverware.(Required) 1 2 3 4 Operate garbage disposal according to manufacturer’s directions and facility policy.(Required) 1 2 3 4 Operate dishwasher according to manufacturer’s directions and facility policy.(Required) 1 2 3 4 Clean pots and pans.(Required) 1 2 3 4 Store clean items(Required) 1 2 3 4 Clean floor areas according to correct procedures.(Required) 1 2 3 4 Clean floor mats according to correct procedures.(Required) 1 2 3 4 Clean walls and ceilings.(Required) 1 2 3 4 Clean and store cleaning equipment.(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. 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In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. 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