This skills assessment is designed to determine your level of competency in the areas listed below. By completing this checklist to the best of your ability, you will help us match your skills and areas of interest with our available assignments. Please indicate your appropriate level for each category as well as the date last performed.

Traveler Name:
Traveler Email:
Recruiter Name:
Date:

COMPETENCY LEVELSDATE LAST PERFORMED
1 = Functionally IndependentWithin 6 Months
2 = Some Experience6 mo. - 12 mo. ago
3 = Minor or No ExperienceOver 1 year ago
 Not Performed / Never Worked

SkillsCompetency LevelDate Last Performed
CARDIOVASCULAR
Abdominal Aortic Bypass
Acute MI
Aneurysm
Angina
Angioplasty (Pre/Post)
Arthrectomy (Post)
Assessment of Auscultation
Assessment of Heart Sounds/Murmurs
Assist With Arterial Line Insert
Assist With Central Venous Line Insert
CABG (Pre/Post)
Cardiac Arrest
Cardiac Cath (Pre/Post)
Cardiac Monitors
Cardiac Tamponade
Congestive Heart Failure
Defibrillation/Cardioversion
Femoral Artery Sheath Removal
Set Up and Management of CVP Readings
Interpretation of CVP Readings
Interpretation of Swan Ganz Readings
Intracoronary Stent Placement
Heart Transplant
Infective Endocarditis
Intra Aortic Balloon Pump
Myocarditis
Open Chest Emergency
Obtain 12 Lead EKG
Basic EKG Interpretation
Cardiac Dysrhythmias
Sinus Dysrhythmias
Atrial Dysrhythmias
Junctional Dysrhythmias
Heart Blocks
Pacemaker Rhythms
Lead Placement
Open Heart Surgery (Post)
Pacemaker(External)
Pacemaker (Permanent)
Pacemaker (Temporary)
Pacemaker (Transthoracic)
Pericardiocentesis
Rotoblade (Post)
Transesophageal Echocardiogram
Ventricular Assist Device
ENDOCRINE
Adrenal Gland Disorders
Insulin Reaction
Diabetic Coma
Diabetic Ketoacidosis
Blood Glucose Monitoring
Tyroidectomy
Pituitary Gland Disorders
GASTROINTESTINAL
Abdominal Infections
Abdominal Trauma
Abdominal Wounds
Acute Intestinal Obstruction
Acute Pancreatitis
Bowel Obstruction
Bowel Sounds
Gastric Lavage
GI Bleeding
GI Surgery (Pre/Post)
GI Tubes and Drains
Hepatitis
Interpretation of Blood Chemistry
Liver Failure
NG Tube Insertion
Septic Shock
INFECTIOUS DISEASE
Care of Patient With AIDS
Care of Patient With Hepatitis
Care of Patient With TB
Fever Management
Isolation
IV THERAPY
Assist With Cut Down
Blood Product Administration
Angiocath
Butterfly
Heparin Lock
Angiography
Broviac/Hickman
Groshong
PICC
Portacath
NATIONAL PATIENT SAFETY GOALS
Accurate Patient Identification
Effective COmmunication With Patient and Family
Infection Control
Interpretation and Communication of Lab Values
Isolation
Labeling
Medication Administration
Minimize Fall Risk
Pain Assessment and Management
Prevention of Pressure Ulcers
Reconciliation
Universal Precautions
Use of PCA
NEUROLOGY
Aneurysm Precautions
Assessment of Neuro Signs
Assist With Lumbar Puncture
AV-Shunt Placement
Basal Skull Fracture
Closed Head Injury
Coma
Cranial Hemorrhage
Craniotomy (Post)
CVA
DTs
Encephalitis
Externalized VP Shunts
Glasgow Coma Scale
Halo Traction
Hypo-Hyperthermia Mattress
Laminectomy
Meningitis
Neuromuscular Disease
Overdose
Seizure Activity
Spinal Cord Injury
PULMONARY
ABGs
ARDS
Assessment of Breath Sounds
Assist With Bronchoscopy
Assist With Chest Tube Inserts
Assist With Thoracentesis
Care of Traceostomy
COPD
Endotracheal Suctioning
Extubation
Intubation
Lobectomy
Lung Transplant
Maintenance of Chest Tube
Maintenance of Drainage System
Management of Ventilator
Nasotracheal Suctioning
Near Drowning
Oral Suctioning
Oximetry
Oxygen Administration
Cannula/Prongs
Venturi Mask
Nebulizer Set Up
Pneumonia
Pneumothorax
Pulmonary Edema
Pulmonary Embolism
Pulse Oximetry
Thoractomy
Tuberculosis
RENAL
AV Fistula/Shunt
Calculi
Chronic/Acute Renal Failure
Foley Catheter - Female
Foley Catheter - Male
GU Irrigations
Peritoneal Dialysis
Renal Trauma
Suprapubic Catheter
Urinary Tract Infection
Interpretation of Lab Results
TURP
TRAUMA
Anaphylactic Shock
Burns - 1st Degree
Burns - 2nd Degree
Burns - 3rd Degree
Cardiogenic Shock
Dressing Change - Simple
Dressing Change - Complex
Hypovolemic Shock
Neurogenic Shock
Septic Shock
Traumatic Amputation
WOUND MANAGEMENT
Assist With Sutures
Assist With Staples
Culdocentesis Tray
Setting Up Suture Tray
Staple Removal
Steri Strips
Suture Removal
Wound Debridement


Age Specific Competency

Please indicate the appropriate level for each category. When evaluating your competency level, please focus on the following guidelines:

Ability to ensure a safe and caring environment for the specific age groups indicated below.
Ability to communicate and instruct patients in the designated age groups.
Ability to evaluate age-appropriate behavior and skills.

Age GroupCompetency LevelDate Last Performed
Newborn (birth-30 days)
Infant (30 days-1 yr)
Toddler (1-3 yrs)
Preschooler (3-5 yrs)
School Age (5-12 yrs)
Adolescents (12-18 yrs)
Young Adults (18-39 yrs)
Middle Adults (39-64 yrs)
Older Adults (64 yrs +)

To the best of my knowledge, the information represented above is an accurate reflection of my skills and abilities, and I authorize Sunbelt Staffing to share the above skills checklist with its clients.