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Skills Assessment - Surgical Technologist
 
The following checklist will be used to match your skills and interests with available assignments. Please enter your information, and we will store this information with your application/profile. Please indicate your level of proficiency by marking the appropriate number.
 
First Name:
Middle Initial:
Last Name:
SSN: - -
E-mail Address:
Home Phone: - -
Work Phone: - -
Cell Phone: - -
City:
State:
 
 
0. Theory, no practice   1. Limited   2. Confident   3. Very Confident
 
Ear, Nose, & Throat: Experience:
Caldwell - Luc 0   1   2   3  
Laryngectomy 0   1   2   3  
Cleft lip/palate repair 0   1   2   3  
Radical neck dissection 0   1   2   3  
 
General Surgery:
Bronchoscopy 0   1   2   3  
Appendectomy 0   1   2   3  
Laparoscopic Appendectomy 0   1   2   3  
Cholecystectomy 0   1   2   3  
Laparoscopic Cholecystectomy 0   1   2   3  
Hernia Repair 0   1   2   3  
Laparoscopic Hernia Repair 0   1   2   3  
Colon Resection 0   1   2   3  
Rectal Surgery 0   1   2   3  
Splenectomy 0   1   2   3  
Thyroidectomy 0   1   2   3  
Whipple Procedure 0   1   2   3  
Abdominal Perineal Resection 0   1   2   3  
 
Gynecology:
Hysterectomy, abdominal 0   1   2   3  
Hysterectomy, vaginal 0   1   2   3  
Tubal ligation 0   1   2   3  
Tuboplasty 0   1   2   3  
Anterior posterior repair 0   1   2   3  
 
Neurosurgery:
Craniotomy for Tumor 0   1   2   3  
Craniotomy for Aneurysm 0   1   2   3  
Ventricular Peritoneal Shunt 0   1   2   3  
Lumbar Laminectomy 0   1   2   3  
Cervical Laminectomy 0   1   2   3  
Posterior Sitting Laminectomy 0   1   2   3  
Transsphenoidal Hypophysectomy 0   1   2   3  
Ulnar Nerve Transposition 0   1   2   3  
 
Opthalmology:
Cataract extraction with IOL 0   1   2   3  
Corneal transplant 0   1   2   3  
Scleral Buckling 0   1   2   3  
 
Orthopedics:
Ankle Surgery 0   1   2   3  
Arthroscopy 0   1   2   3  
Hand Surgery 0   1   2   3  
Micro Hand Surgery 0   1   2   3  
Hip Prosthesis 0   1   2   3  
Knowles Pinning 0   1   2   3  
Spinal Fusion 0   1   2   3  
ACL Repair 0   1   2   3  
Shoulder Surgery 0   1   2   3  
Total Knee Surgery 0   1   2   3  
Total Hip Replacement 0   1   2   3  
ORIF 0   1   2   3  
 
Plastics:
Liposuction 0   1   2   3  
Rhinoplasty 0   1   2   3  
Face Lift 0   1   2   3  
Skin Graft 0   1   2   3  
Breast Reconstruction 0   1   2   3  
Breast Reduction 0   1   2   3  
Cleft Lip/Palate Repair 0   1   2   3  
 
Thoracic & Open Heart:
Open Heart Bypass 0   1   2   3  
Open heart Valve Replacement 0   1   2   3  
Aortic Aneurysm Repair 0   1   2   3  
Thoracotomy 0   1   2   3  
Lung Resection 0   1   2   3  
Pneumonectomy 0   1   2   3  
 
Urology:
Cystectomy 0   1   2   3  
Kidney Transplant 0   1   2   3  
Nephrectomy 0   1   2   3  
Prostatectomy 0   1   2   3  
Ureterolithotomy 0   1   2   3  
Vasectomy 0   1   2   3  
Implants; penile, testicular 0   1   2   3  
Adult Circumcision 0   1   2   3  
Orchiopexy 0   1   2   3  
 
Vascular:
A-V access graft 0   1   2   3  
Carotid Endarterectomy 0   1   2   3  
Peripheral vascular bypass procedures 0   1   2   3  
Thrombectomy/embolectomy 0   1   2   3  
Vena cava filter/umbrella 0   1   2   3  
 
Equipment:
Argon beam coagulator 0   1   2   3  
Bair Hugger 0   1   2   3  
Blood/fluid warmer 0   1   2   3  
Cell saver 0   1   2   3  
Use of Cavitron machine 0   1   2   3  
Lasers 0   1   2   3  
Pleur-evac disposable chest drainage 0   1   2   3  
Steri-vac aeration cabinet, 3-M, portable 0   1   2   3  
Steris unit 0   1   2   3  
Suction unit, disposable 0   1   2   3  
Washer sanitizer - AMSCO 0   1   2   3  
Washer sterilizer - AMSCO 0   1   2   3  
 
Age-Specific Practice Criteria:
Please check the box corresponding to each age group for which you have expertise in providing age-appropriate nursing care. Pediatric (1 - 12years)  
Adolescents (12 - 18 years)  
Adult (19 - 65 years)  
Older Adult (Older than 65 years)  
 
Experience With Age Groups:
Assess immunization status for pediatric, and adolescent 0   1   2   3  
Set age-appropriate short-term and long-term goals in care planning 0   1   2   3  
Provide age-appropriate education, considering possible vision and hearing impairment for older than 65 years 0   1   2   3  
 
 
 
 


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