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Medical Laboratory Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided to FILL IN THE BLANK 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 |
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| Rating Stars (Click) | Medical Laboratory | 1 | 2 | 3 | 4 | ||
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Blood bank | ||||||
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Chem | ||||||
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Hemo | ||||||
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Micro | ||||||
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Serol | ||||||
| Rating Stars (Click) | Medical Laboratory | 1 | 2 | 3 | 4 | ||
| Procedure | |||||||
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Patient positioning | ||||||
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Fingerstick | ||||||
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Venipuncture | ||||||
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Warming the puncture site | ||||||
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Tourniquet application & removal | ||||||
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Decontamination of the puncture site | ||||||
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Tuberculosis exposure control plan | ||||||
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Post venipuncture site care | ||||||
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Order of tube collection | ||||||
| Equipment | |||||||
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Arterial blood gas kits | ||||||
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Occult blood packets | ||||||
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Heel warmers | ||||||
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Pin worm kits | ||||||
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Serum separators | ||||||
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Blood culture preparation kits | ||||||
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Centrifuge | ||||||
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Capillary blood kits | ||||||
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Bacteria media | ||||||
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Drug screen kits | ||||||
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Ova parasite containers | ||||||
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Legal blood draw kits | ||||||
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Paternity blood draw kits | ||||||
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RSV kits | ||||||
| Rating Stars (Click) | Chemistry | 1 | 2 | 3 | 4 | ||
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Acetone analysis | ||||||
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Atomic absorption | ||||||
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B12/folates | ||||||
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CSF protein | ||||||
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Drug monitoring | ||||||
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Electrolytes | ||||||
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Electrophoresis | ||||||
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Gas chromatography | ||||||
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Hepatitis | ||||||
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Hormone testing | ||||||
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Immunoelectrophoresis | ||||||
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Include blood gas | ||||||
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Main chemistry unit | ||||||
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Osmolality | ||||||
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Stool analysis (fecal fats) | ||||||
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Thin layer chromatography | ||||||
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Thyroid testing | ||||||
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Tumor markers | ||||||
| Rating Stars (Click) | RIA | 1 | 2 | 3 | 4 | ||
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Background counts | ||||||
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Counters | ||||||
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Curves/regressions | ||||||
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Data reduction | ||||||
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Instrumentation/gamma | ||||||
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Radiation safety techniques | ||||||
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Scintillation counter | ||||||
| Rating Stars (Click) | Blood Bank | 1 | 2 | 3 | 4 | ||
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Antibody identification | ||||||
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Antibody titer | ||||||
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Blood irradiation | ||||||
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Component preparation | ||||||
| Coombs test: | |||||||
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Direct | ||||||
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Indirect | ||||||
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Cross match | ||||||
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Donor unit collections | ||||||
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Emergency release | ||||||
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Freezing blood | ||||||
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Immediate spin cross match | ||||||
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Patient identification | ||||||
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Plasmapheresis | ||||||
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Plateletpheresis | ||||||
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Procedures | ||||||
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Rhogam | ||||||
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Antigen typing | ||||||
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Type, RH | ||||||
| Rating Stars (Click) | Microbiology/Virology | 1 | 2 | 3 | 4 | ||
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Concentration techniques | ||||||
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Identification | ||||||
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Acid fast stain (fluorescent) | ||||||
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Acid fast stain (kinyoun) | ||||||
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Anaerobic culture | ||||||
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Anaerobic identification | ||||||
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Blood culture | ||||||
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C. difficile assay | ||||||
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Cell culture technique (viral) | ||||||
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Chlamydia culture | ||||||
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Chlamydia smear | ||||||
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Culture plating | ||||||
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Darkfield | ||||||
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Gram stain | ||||||
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India ink | ||||||
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KOH prep | ||||||
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Malarial examination | ||||||
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Myobacteria culture | ||||||
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Occult blood | ||||||
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Organism identification | ||||||
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Ova & parasite concentration | ||||||
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Trichcone | ||||||
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Wet mount | ||||||
| Sensitives: | |||||||
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K.B. | ||||||
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M.I.C. | ||||||
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Virus isolation | ||||||
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Wet mount-motility | ||||||
| Rating Stars (Click) | Urinalysis | 1 | 2 | 3 | 4 | ||
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Automated instrumentation: | ||||||
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Large volume automation equipment | ||||||
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Small volume automation equipment | ||||||
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Crystal identification | ||||||
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Macroscopic U.A | ||||||
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Microscopic U.A | ||||||
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Semen analysis | ||||||
| Rating Stars (Click) | Hematology | 1 | 2 | 3 | 4 | ||
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Bleeding time | ||||||
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Body fluid count | ||||||
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CBC | ||||||
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D-dimer | ||||||
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Differential | ||||||
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Eosinophil count | ||||||
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Factor assays | ||||||
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Fetal hemoglobin | ||||||
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Fibrin split products/FDP | ||||||
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Fibrinogen | ||||||
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Lee-White clotting time | ||||||
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Platelet aggregation | ||||||
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Platelet count | ||||||
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PT & PTT | ||||||
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Reticulocyte count | ||||||
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Sedimentation rate | ||||||
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Special stains (PAS, peroxidase, leukocyte alkaline phosphatase) | ||||||
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Sickle cell prep | ||||||
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Thrombin time | ||||||
| Rating Stars (Click) | Serology / Immunology | 1 | 2 | 3 | 4 | ||
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ANA | ||||||
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ASO titer | ||||||
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C3, C4, total complement | ||||||
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Cold agglutinins | ||||||
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C-reactive protein | ||||||
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ELISA testing | ||||||
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Febrile agglutinations | ||||||
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Fluorescent testing | ||||||
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FTA-ABS | ||||||
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Hemagglutination inhibition | ||||||
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LE cell prep | ||||||
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Monospot | ||||||
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Pregnancy testing | ||||||
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Radial immuno diffusion | ||||||
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Rheumatoid factor | ||||||
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RPR | ||||||
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Rubella serology | ||||||
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TORCH studies | ||||||
| Rating Stars (Click) | National Patient Safety Goals | 1 | 2 | 3 | 4 | ||
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Accurate patient identification | ||||||
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Labeling | ||||||
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Effective communication | ||||||
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Infection control | ||||||
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Quality control/quality assurance | ||||||
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Assist with On-site procedure | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Newborn / neonate (Birth-30 days) | ||||||
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Infant (31 days-1 year) | ||||||
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Toddler (2-3 years) | ||||||
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Preschool (ages 4-5 years) | ||||||
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School Age (ages 6-12 years) | ||||||
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Adolescents (ages 13-21 years) | ||||||
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Young Adult (ages 22-39 years) | ||||||
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Adults (ages 40-64 years) | ||||||
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Older Adult (ages 65-79 years) | ||||||
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Elderly (80+ years) | ||||||
| Please list any Additional Skills: | |||||||
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| Additional training: | |||||||
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| Additional training: | |||||||
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