SunbeltStaffing.com Skills Self Assessment

Operating Room Tech
Skills Self Assessment

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 LEVELS	DATE LAST PERFORMED
1 = Functionally Independent	Within 6 Months
2 = Some Experience	6 mo. - 12 mo. ago
3 = Minor or No Experience	Over 1 year ago
	Not Performed / Never Worked

Skills	Competency Level	Date Last Performed
GENERAL SURGERY
Adrenalectomy
Appendectomy
Bowel Repairs/Resections
Cholecystectomy
Colectomy
Colonoscopy/Sigmoidoscopy
Colostomy/Ileostomy
Esophageal Resection
Esophagoscopy
Gastrectomy
Gastric Bypass/Stapling
Gastroscopy
Hemorrhoidectomy
Hepatic Resection
Herniations (Hiatal, Diaphragm)
Herniorrhaphy (Femoral/Inguinal)
Laparoscopy
Laparotomy
Mastectomy
Minor Case setup
Nephrectomy
Nissen Fundoplication
Pancreatectomy
Pilonidal Cystectomy
Portal/Caval Shunt
Pyloric Stenosis
Rectal Cases
Splenectomy
Transabdominal
Vagotomy/Pyloroplasty
Whipple Procedure
EAR, NOSE, THROAT
Acoustic Neuroma
Cleft Lip/Palate Repair
Endoscopic Sinus Surgery
Ethmoidectomy
Fenestration Procedure
Glossectomy
Laryngectomy
Laryngoscopy
Mandibular Fractures
Mastoidectomy
Maxillary Fractures
Myringoplasty
Myringotomy/PE Tubes
Neck Dissection
Open Reduction Facial Fractures
Open Reduction Tripod Fractures
Orbital/Zygomatic Fractures
Parathyroidectomy
Reduction Nasal Fracture
Stapedectomy
T & A
Thyroidectomy
Tracheostomy
Tympanoplasty
Vocal Cord Stripping
TRAUMA
Blunt Traumatic Injuries
Burns
Multiple Injuries
Penetrating Traumatic Injuries
CARDIOVASCULAR
Angioplasty
Aortic Aneurysm
Aortic Balloon Insertion
Aortic Valve Replacement
Atrial Septal Defect Repair
A-V Fistula/Shunt
Carotid Endarterectomy
Central Venous Access Placements
Coarctation of Aorta-Resection
Coronary Artery Bypass Graft
Fem-Popliteal Bypass Graft
Mitral Valve Replacement
Pacemaker Implantation
Pacemaker Insertion
Patent Ductus Arteriosus
Pericardial Procedures
Port-A-Cath Insertion
Tetralogy of Fallot
Vein Harvest
Ventral Septal Defects-Repair
Ventricular Aneurysm
OPTHAMOLOGY
Cataract
Detached Retina
Iridotomy
LASIK
Lid and Muscle Procedures
Orbit/Globe Fractures
Pterygium Repair
ORAL
Closed Reduction Facial Fxs/Wiring
Excision Odontoma
Extraction of Deciduous Teeth
Extraction of Impacted Molars
Fractures Jaw, Mandible, Zygoma
LeFort Osteotomies
Maxillary Procedure with Graft
TMJ with Exploration/Arthroplasty
ORTHOPEDIC
ACL Repair
Amputation Arm/Leg
Arthroscopy-Ankle
Arthroscopy-Elbow
Arthroscopy-Knee
Arthroscopy-Shoulder
Cast Application
Closed Fracture Reduction
External Fixations
Foot Procedure/Fractures
Hand Surgery/Fx Repairs
Harrington Rod Insertion-
IM Rods
Nailing Procedures
ORIF-Lower Extremity
ORIF-Upper Extremity
Spica Cast Application
Spinal Fusion
Total Hip Replacement
Total Knee Replacement
Total Shoulder Replacement
UROLOGY
Circumcision
Cystoscopy
Hydrocelectomy
Hypospadias Repair
Incontinence Device Placement
Lithotripsy
Orchiopexy
Penile Prothesis
Prostatectomy
Radical Node Dissection
TURP
Vasectomy
OB/GYN
A &amp;amp; P Repair
Abdominal Hysterectomy
Colposcopy
C-Section
Dilation &amp;amp; Curettage
Laparoscopy
Marshall Marchetti
Marsupialization Bartholin Cyst
Salpingoplasty
Suction Curettage
Tubal Ligation
Vaginal Hysterectomy
Vulvectomy
PLASTICS
Abdominoplasty
Blepharoplasty
Dermabrasion
Facelifts
Mammoplasty-Augmentation
Mammoplasty-Reduction
Muscle Flaps
Otoplasty
Pedicle Grafts
Rhinoplasty
Scar Revisions
Septoplasty
Skin Grafts/Split Thickness
Vein Stripping
TRANSPLANT
Bone-Harvest/Transplant
Eye-Harvest/Transplant
Heart-Harvest/Transplant
Liver-Harvest/Transplant
Lung-Harvest/Transplant
Pancreas-Harvest/Transplant
Renal-Harvest/Transplant
Skin-Harvest/Transplant
EQUIPMENT
Aquamatic K Thermia Unit
Argon Beam Coagulator
Arthroscopy Cameras
Blood Warmer
Bovie Electrosurgical Unit
Cardiac Monitor-Defibrillator
Cell Saver
Centrifuge
Cidex Sterilization
Cry-Ophthalmic Unit
Dermatome
Drills
Dual Tract Lights
Ethylene Oxide Sterilizer
Fiber Optic Illuminator
Flash Autoclave
Fluid Pumps
Kiddie Pneumatic Tourniquet
Lasers
Nerve Stimulator
Operating Microscope
Pleur-e-vac Units
Shavers
Stapling Instrument
Suction Unit Disposable
Ultrasonic Cleaner-AMSCO
Vac-pac Positioner
Washer Sterilizer-AMSCO
THORACIC
Bronchoscopy
Chest Tubes
Esophageal Repair
Mediastinoscopy
Pneumonectomy/Lobectomy
Thoracic Aortic Aneurysm
Thoracoplasty
Thoracotomy
Tracheal Resection
CRANIOTOMY
Aneurysm
Cervical Fusion
Cervical Laminectomy
Cranioplasty
Crutchfield Tong Insertion
Halo Traction Application
Hypophysectomy
Laminectomy
Meningocele Repair
Shunt Insertions
Trauma
Tumor
Ventricular Procedures
NEUROLOGY
Acoustic Neuroma
Anterior Cervical Fusion
A-V Malformation
Burr Holes
Carotid Ligation
Cervical Sympathectomy
Craniotomy
Discectomy
Laminectomy
Myelomeningocele Repair
Shunt Procedure
Ulnar Nerve Transfer
Ventriculostomy
Please list any licenses or certifications held and when they expire:

Please list any area of competence (techniques, procedures, technologies, skills, etc.) where you would like to pursue additional training in order to enhance the level of care, treatment, or services to the population(s) that you serve:

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 Group	Competency Level	Date Last Performed
Newborn (birth-30 days)
Infant (30 days-1 yrs)
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.