Personal Information

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Legends

1 = No experience; Theory/observed only

2 = Limited competency; < 5 times per year; Needs supervision

3 = Acceptable competency; > 5 times per year

4 = Competent; Performs on a daily or weekly basis; Proficient

Tests

Test Control

Recording

I hereby certify that ALL information I have provided to Trice Healthcare on this skillschecklist is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Legends

Work Settings

Processing

Decontamination

Assembly and Preparation

Tests

Safety Procedures

Specialty Equipment Processing

Sterilization (1.Steam Autoclave)

Sterilization (2.Sterility Assurance Tests)

Sterilization (3.Steam Sterilization)

Sterilization (4.Gas (ETOH)

Sterilization (5.Sterrad)

Sterilization (6.Steris)

Computer Charting/EMR

Age Specific Practice Criteria