Surgical Tech Skills Checklist
  Surgical Tech Skills Checklist
   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) Skill Level 1 2 3 4  
  General Surgery  
AKA/BKA (amputation)  
Abdominal-Perineal Resection  
Cholecystectomy (Open)  
Exploratory Laparotomy  
Appendectomy  
  Laparoscopic Procedure  
Cholecystectomy  
Appendectomy  
Hernia  
Nissan  
Colectomy  
Gastrectomy  
Inguinal / Ventral Hernia Repair  
Spienectomy  
Bowel Resection / Colostomy  
Thyroidectomy  
Rectal Procedures  
Esophagascopy / Gastroscopy  
  Pediatric Case  
Inguinal Hernia Repair  
Pyloric Stenosis  
Circumcision  
Exploratory Laparotomy  
  E.N.T  
Middle Ear Cases  
T&A  
Myringotomy  
Tympanoplasty  
Radical Neck Dissection  
Septoplasty  
Sinus Endoscopy  
  Cardiac / Thoracic / Vascular  
Coronary Artery By-pass  
Mitral Valve Repair / Replacement  
Aortic Valve Replacement  
Multiple Valve Transposition  
Septal Defects  
Ventricular Aneurysm Repair  
Bring Back Heart  
Pericardial Window  
Intra-Aortic Balloon Insertion  
Heartport or Similar CABG  
Thoraco Approach Mid-Cab  
Aortic Arch Replacement  
Aortic Valve Conduit  
Mechanical Heart / LVAD  
Pediatric Hearts  
Tetrology of Fallot  
Chamberlin Procedure  
AICD Insertion  
Saphenous Vein Harvest  
Endoscopic Vein Harvest  
Gastric Artery Harvest  
Radial Vein Harvest  
Insertion Vena Cava Filter  
Thoracotomy  
Thoracoscopy  
Insertion Chest Tube  
Esophageal Repair  
Pneurnonectomy / Lobectomy  
Mediastinodcopy  
Desendind Aortic Repair  
Arterial Stenting  
Intra-Operative Angioplasty  
  Vascular Surgery  
Carotid Endarterectomy  
Abdominal Aortic Aneurysm  
  Femoral    
Popliteal By-pass Graft (Insitu)  
Popliteal By-pass Graft (Graph)  
Portacath, Tesio, Hickman Placement  
AV Shunt  
Thrombectomy  
Pacemaker Insertion  
Arterial Stenting  
Intra-Operative Angioplasty  
Subclavin / Carotid By-pass  
  Orthopedics  
Total Hip Replacement  
Bipolar Hip  
Compression Hip Screw  
Total Knee Replacement  
Knee Arthroscopy  
ACL Knee Repair  
Harrington Rod or Similar  
I.M. Rodding  
Hand Procedures  
Foot Procedures  
  Mini, Standard, Large Fragment    
Screws & Plates  
External Fixation  
Shoulder Repair  
Shoulder Arthroscopy  
Spinal Fusion  
Cast Application  
Fracture Table Set-up  
Drills, Saws and Reamers  
  Urology  
Radical Prostatectomy  
Radical Lymph Node Dissection  
Ureteroscopy  
TURP / TURST  
Ultrasonic Lithotripsy  
Hydrocelectomy  
Cystoscopy  
Insertion Penile Prosthesis  
  Gynecology  
D & C  
Diagnostic Laparascope  
Laparoscopic Vaginal Hysterectomy  
Abdominal Hysterectomy  
Vaginal Hysterectomy  
Anterior Repair  
Posterior Repair  
MMK (Marshall Marchetti Krantz)  
Tuboplasty  
BTL (Bilateral Tubal Ligation)  
C-Sections  
  Neurology  
Cervical Laminectomy (Anterior)  
Cervical Laminectomy (Posterior)  
Lumbar Laminectomy Discectomy  
Percutaneous Micro Discectomy  
Craniotomy For Tumor  
Craniotomy For Aneurysm  
Burr Holes  
VP Shunts  
Transphenoidal Hypothypectomy  
Carpal Tunnel Repair  
Harrington Rod or Similar  
  Trauma Surgery  
Transplant Surgery  
Organ Procurement (Harvest)  
  Plastics  
Mammoplasty  
Facelifts  
Skin Grafts  
Rhinoplasty  
Cleft Lip Repair  
Abdominalplasty  
Blepharoplasty  
Otoplasty  
Muscle Flaps  
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)