Skills Checklist:
MT/MLT

Skills Checklist – MT/MLT

Crystal Identification*

Macroscopic Analysis*

Microscopic Analysis*

Pregnancy Testing*

This self-evaluation is for assessing your experience in specific clinical areas. This self-evaluation will not be a determining factor in accepting your application to become an employee of Connected Health Care.

0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced

CERTIFICATIONS(Required)

BLOOD BANK(Required)

	0	1	2	3	4	5
Patient Identification Process*
ABO/Rh/Antibody Screen & ID*
Crossmatch- Immediate Spin/ IgG*
Antigen Typing*
Antibody Typing: Gel Method*
Antibody Typing: Tube Method*
Cold Agglutinins*
Rhogam Screening*
Coombs Test Direct*
Coombs Test Indirect*
Cord Blood Evaluation*
Thawing/ Cooling of Blood Products*
Donor Collection Procedures*
Issue Blood Product to Pt. Care Area*
Emergency Release*
Elutions*
Transfusion Reaction Workshop*
Irradiating Packed Cells*
Splitting a Baby Unit*

CHEMISTRY(Required)

	0	1	2	3	4	5
Overdose/ Withdrawl*
Suicidal Precautions*
Manic Disorder/ Behavior*
De-escalation techniques*
Depression*
Topical*
Otic*
Rectal*
Vaginal*
Specimen Preparation*
Acetone Analysis*
Arterial Blood Gas*
B- Folates*
Cardiac Enzymes*
Chromatography- Gas*
Chromatography- Thin Layer*
Electropheresis*
Hormone/ Thyroid*
Immunoassay*
Osmolality*
Therapeutic Drug Monitoring*
Tumor Markers*
Analyzer Use/ Troubleshooting*
Review & Interpretation of QC*

HEMATOLOGY / COAGULATION(Required)

	0	1	2	3	4	5
Automated Instrument Use*
Differential Manual*
Sed Rate Manual*
Reticulocyte Count*
Fetal Hemoglobin*
RBC Morphology*
Platelet Count*
Sickle Cell Prep*
Platelet Morphology*
Body Fluid Manual Cell Count*
Body Fluid Manual diff.*
Special Stains- e.g. PAS, LAP, Peroxidase*
WBC Stool*
Semen Analysis*
PT/PTT/INR*
D-Dimer*
Fibrinogen*
Factor Assays*
Fibrin Degradation Products*
Thrombin Time*
Platelet Function Analysis*

IMMUNOLOGY / SEROLOGY(Required)

MICROBIOLOGY(Required)

	0	1	2	3	4	5
Plating Micro Specimens*
Reading Plates*
Gram Stains*
Kit Testing- Monospot/ ASO Titer*
Kit Testing- Flu/Rapid Strep/ RSV*
Wet Prep/ KOH Prep*
AFB Stain/ Culture*
O&P*
CDiff*
Occult Blood*
Chlamydia*
Processing Specimens for Viral/ Fungal Cultures*

URINALYSIS(Required)

PHLEBOTOMY(Required)

	0	1	2	3	4	5
Newborn/Neonate (birth to days)*
Infant ( month to year)*
Toddler ( year to years)*
Preschooler ( years to years)*
School Age Child ( years to years)*
Adolescents ( years to 8 years)*
Young Adults (8 years to 9 years)*
Middle Adults (9 years to 6 years)*
Older Adults (6 years to 79 years)*
Elderly Adults (over 79+ years)*
Patient Identification*
PPE Equipment (Gloves, Mask, Etc.)*
Adult Venipuncture*
Pediatric Venipuncture*
Dermal Stick (Finger/Heel)*
Butterfly Draw*
Arterial Draw*
Tube Types and Usage*
Centrifuge Operations*
Bleeding Time*
Blood Culture Collections*
Blood Alcohol Collections*
Drug Screening Collections*

Name

First Last

Date

Specialty

By Signing this, I am authorizing that the information I have given is true and accurate to the best of my knowledge. I hereby authorize Connected Health Care to release this Skills Checklist to staffing clients of Connected Health Care. Submit this skills evaluation with your initial application.

Signature(Required)

	YES	NO
ASCP MT/MLS*
ASCP MLT*
HEW*
AMT*
Other

	0	1	2	3	4	5
RPR/ RPR Titer*
Rheumatoid Titer*
ANA*
LE Prep*
HIV Rapid*
HIV Antibody Detection*
Rubella*
CMV*