|
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) | ||||||