The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate your level of experience/proficiency with each area and, where applicable, the types of equipment and/or systems you are familiar with. Use the following key as a guideline:
A) Theory Only/No Experience-Didactic instruction only, no hands on experience
B) Limited Experience-Knows procedure/has used equipment, but has done so infrequently or not within the last six months
C) Moderate Experience-Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed.
D) Proficient/Competent-Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach.
J. THORACIC & OPEN HEART
K. TRANSPLANT
L. TRAUMA
M. UROLOGY
N. VASCULAR
N. VASCULAR
O. EQUIPMENT
AGE SPECIFIC PRACTICE
A.Newborn/Neonate (birth - 30 days)
B.Infant (30 days - 1 year)
C.Toddler (1 - 3 years)
D.Preschooler (3 - 5 years)
E.School age children (5 - 12 years)
G.Young adults (18 - 39 years)
H.Middle adults (39 - 64 years)
I.Older adults (64+)
My experience is primarily in: (Please indicate number of years) Cardiothoracic
The information I have given is true and accurate to the best of my knowledge. I hereby authorize
PACE Medical Staffing, Inc. to release Surgical Technician Skills Checklist to client facilities of Pace Medical Staffing, Inc. in
relations to consideration of employment as a Traveler with those facilities.