STERILE PROCESSING TECHNOLOGIST SKILLS
  STERILE PROCESSING TECHNOLOGIST SKILLS
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
       
Rating Stars (Click) Processing 1 2 3 4  
Single instruments  
Endoscopes  
Repair  
Sets/ Trays  
Care of instruments  
Other (list):  
Rating Stars (Click) Decontamination 1 2 3 4  
Manual cleaning  
Washer sterilizer  
Soiled linen  
Disinfectants  
Sharps  
Disposable items  
Cleaning equipment  
Detergents  
Dress code  
Other (list):  
Rating Stars (Click) Steam Sterilization 1 2 3 4  
Chart recording  
Biological monitoring  
Time  
Testing/ Monitoring  
Other (list):  
Rating Stars (Click) Tests 1 2 3 4  
Test control  
Recording  
Other (list):  
Rating Stars (Click) Assembly andPreparation 1 2 3 4  
Wrapping materials  
Autoclave tape  
Dust covers  
Proper towel/ linen folding  
Proper labeling  
Expiration dates  
Packing for steam  
Heat sealing  
Instrument count sheets  
Placing instruments on trays  
Other (list):  
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
Infant (Birth - 1 year)  
Preschooler (ages 2-5 years)  
Childhood (ages 6-12 years)  
Adolescents (ages 13-21 years)  
Young Adults (ages 22-39 years)  
Adults (ages 40-64 years)  
Older Adults (ages 65-79 years)  
Elderly (ages 80+ years)