Skills Checklist - Operating Room

15849 N. 71st Street . Suite 100 - Scottsdale, AZ 85254 Toll Free: (877) 280-2600 - Fax: (877) 280-5200

Please mark your level of experience
For the skills listed below please check if you are:
1 No Experience: Theory/Observed Only
2 Intermittent Experience: 5 Times Per Year; Needs Review
3 Moderate Experience: 5 Times Per Year; May Need Minimal Resource
4 Competent: Performs on Daily or Weekly Basis; Proficient

To StaffingMedical USA Employees:

The following checklist is a competency tool used to match your skills with available assignments. Please rate your ability to perform these skills as accurately as possible by checking the appropriate boxes. The information I have given here is true and accurate to the best of my knowledge. I authorize StaffingMedical USA to release this checklist to client hospitals for the purpose of placing me on a travel assignment.

Name Date Email


SCRUB
SCRUB
 EPLN
Appendectomy
Cholecystectomy
Colon Resection
Hernia Repair
Colostomy
Ileostomy
Bowel Resection
Abdominal Perineal Resection
Adrenalectomy
Gastrectomy
Hemicolectomy
Pancreatectomy
Hiatal Hernia Repair
Hepatic Resection
Organ Procurement
Mastectomy
Splenectomy
Thyroidectomy
Tracheostomy
Whipple
Saphenous Vein Stripping
Anterior Cervical Fusion
Burr holes
Subdural Hematoma
Craniotomy
Laminectomy
Meningocele Repair
VP/VA Shunt Procedures
Cystoscopy / Cystostomy
Circumcision
Hypospadias Repair
Lithotripsy
Kidney Transplant
Nephrectomy
Orchiectomy
Penile Implant
Prostatectomy
Vasectomy
TURP
Leg / Arm Amputation
Application of Halo Traction
Anthroscopy
Total Joint Replacement
Spinal Fusion
ORIF Procedures
Dislocation Repair
Spica Case Application
External Compression Devices
Closed Pinning and Reduction Of Extremities
Insertion of Finger Prosthesis
Patellectomy
Tendon Implants
Reanastomosis
Abdominal Hysterectomy
Vaginal Hysterectomy
C-Section
D and C
Laser Surgery
Radium Insertion
Salpingo Oophorectomy
Termination of Pregnancy
Tubal Ligation
Vaginal Reconstruction
A-V Shunts
Heart Transplant
Liver Transplant
Lung Transplant
Thromobectomy
Repair of Septal Defects
Pericardial Windows
IAPB Insertion
Internal Pacemaker
External Pacemaker
Fem-Pop Bypass
Carotid Endarterectomy
Femoral Endartectomy
Cardiac Valve Replacement
Aortic-Femoral Bypass
Aortic-Femoral Graft
Abdominal Aortic Aneurysm
Cataract Removal
Repair of Retinal Detachment
Corneal Transplant
Refractive Keratoplasty
Iliac Crest Bonegraft
Iliac Crest Bonegraft
Mastoidectomy
Parotidectomy
Septoplasty
Tonsillectomy
Adenoidectomy
Nasal Polypectomy
Radical Neck Dissection Radical Neck Dissection
Plastic Surgery
Cleft Lip / Pallate Repair
Endoscopy Procedures


CIRCULATE
CIRCULATE
Appendectomy
Cholecystectomy
Colon Resection
Hernia Repair
Colostomy
Ileostomy
Bowel Resection
Abdominal Perineal Resection
Adrenalectomy
Gastrectomy
Hemicolectomy
Pancreatectomy
Hiatal Hernia Repair
Hepatic Resection
Organ Procurement
Mastectomy
Splenectomy
Thyroidectomy
Tracheostomy
Whipple
Saphenous Vein Stripping
Anterior Cervical Fusion
Burr holes
Subdural Hematoma
Craniotomy
Laminectomy
Meningocele Repair
VP/VA Shunt Procedures
Cystoscopy / Cystostomy
Circumcision
Hypospadias Repair
Lithotripsy
Kidney Transplant
Nephrectomy
Orchiectomy
Penile Implant
Prostatectomy
Vasectomy
TURP
Leg / Arm Amputation
Application of Halo Traction
Anthroscopy
Total Joint Replacement
Spinal Fusion
ORIF Procedures
Dislocation Repair
Spica Case Application
External Compression Devices
Closed Pinning and Reduction Of Extremities
Insertion of Finger Prosthesis
Patellectomy
Tendon Implants
Reanastomosis
Abdominal Hysterectomy
Vaginal Hysterectomy
C-Section
D and C
Laser Surgery
Radium Insertion
Salpingo Oophorectomy
Termination of Pregnancy
Tubal Ligation
Vaginal Reconstruction
A-V Shunts
Heart Transplant
Liver Transplant
Lung Transplant
Thromobectomy
Repair of Septal Defects
Pericardial Windows
IAPB Insertion
Internal Pacemaker
External Pacemaker
Fem-Pop Bypass
Carotid Endarterectomy
Femoral Endartectomy
Cardiac Valve Replacement
Aortic-Femoral Bypass
Aortic-Femoral Graft
Abdominal Aortic Aneurysm
Cataract Removal
Repair of Retinal Detachment
Corneal Transplant
Refractive Keratoplasty
Iliac Crest Bonegraft
Iliac Crest Bonegraft
Mastoidectomy
Parotidectomy
Septoplasty
Tonsillectomy
Adenoidectomy
Nasal Polypectomy
Radical Neck Dissection Radical Neck Dissection
Plastic Surgery
Cleft Lip / Pallate Repair
Endoscopy Procedures


RN Experience
Indicate Years as 3/93
BMT
Burn unit
ER
HTU
ICU
L & D
Med/Surg
Neuro
NICU
Nurser
Oncology
OR
Orthopedics
OB/GYN
Pediatrics
PICU
Psych
Rehab
TELE


Certifications
Expiration Date
ACLS
BCLS
CCRN
NALS
NRP
PALS
TNS


Signature Date