Skills Checklist:
Surgical Technologist

Skills Checklist - Surgical Technologist

SCRUB SKILLS

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

Hysterectomy*

Cholecystectomy*

Appendectomy*

Hernia Repair*

Colon Resection*

GENERAL SURGERY(Required)

	0	1	2	3	4	5
Abdominal Perineal Resection*
Adrenalectomy*
Bowel Resection*
Cholecystectomy*
Colostomy/ Ileostomy*
Gastrectomy*
Hemicolectomy*
Hepatic Resection*
Herniorrhaphy-Femoral/ Inguinal*
Hiatal Herniorrhaphy- Transabdominal*
Pancreatectomy*
Organ Procurement*
Radical Mastectomy*
Saphenous Vein Ligation and Stripping*
Splenectomy*
Thyroidectomy*
Tracheostomy*
Whipple Procedure*

LAPAROSCOPIC PROCEDURES(Required)

GYNECOLOGY(Required)

	0	1	2	3	4	5
Caesarean Section*
Dilation & Curettage*
Hysterectomy- Vaginal*
Hysterectomy- Abdominal*
Laser Surgery*
Radium Insertion*
Salpingo- Oopherectomy*
Shirodkar Procedure*
Termination of Pregnancy*
Tubal Ligation*
Vaginectomy*
Vaginal Reconstruction*

G.U. AND CYSTO(Required)

ORTHOPEDIC(Required)

	0	1	2	3	4	5
Amputation- Leg/ Arm*
Application of Halo Traction*
Arthroscopy/ Arthrotomy*
Closed Pinning & Reduction of Extremities*
External Compression Devices*
Insertion of Finger Prosthesis*
Total Joint Replacement- Knee, Hip, Shoulder*
Spinal Fusion- Harrington Rods*
Spica Cast Application*
O.R.I.F.- Shoulder, Hip, Humerus, etc.*
Repair of Dislocation*
Patellectomy*
Tendon Implants & Reanastomosis*

NEUROSURGERY(Required)

PLASTICS(Required)

	0	1	2	3	4	5
Face Lift*
Skin Grafting*
Abdominoplasty/ Abdominal Lipectomy*
Augmentation Mammoplasty*
Cleft Lip/Palate Repair*
Dermabrasion*
Digital Flexor Tendon Repair*
Liposuction*
Myelomeningocele Repair*
Otoplasty*
Rhinoplasty*
Reduction of Facial Fracture*

EYE(Required)

	0	1	2	3	4	5
Excision of Chalazion*
Canthotomy*
Correction of Ectropian/ Entropian*
Corneal Transplant*
Enucleation*
I.O.I. Implants*
Lacrimal Duct Probing*
Refractive Keratoplasty*
Repair of Retinal Detachment*
Vitrectomy*

EAR, NOSE & THROAT(Required)

	0	1	2	3	4	5
Caldwell-Luc*
Ethymoidectomy*
Frontal Flap Sinus Procedure*
Laryngectomy*
Open Reduction Facial Fractures*
Radical Neck*
Tonsillectomy & Adenoidectomy*
Myringotomy*
Mastoidectomy*
Tympanoplasty*
Stapedectomy*
Nasal Polypectomy*
Laryngoscopy*

THORACIC(Required)

ENDOSCOPY(Required)

CARDIOVASCULAR(Required)

	0	1	2	3	4	5
A-V Shunts*
Aortic Aneurysm, Abdominal*
Aorto-Femoral Bypass*
Graft Insertion*
Cardiac Valve Replacement*
Coronary Artery Bypass Graft-on Pump*
Endarterectomy-Carotid/Femoral*
Femoral-Popliteal Bypass*
External Temporary Pacemaker*
Internal Pacemaker Insertion*
Intra-Aortic Balloon Pump Catheter*
Patent Ductus Repair*
Pericardial Windows*
Repair of Septal Defects*
Thrombectomy*
Vena Cava Ligation*

TRANSPLANTS(Required)

EQUIPMENT(Required)

STERILIZATION OF EQUIPMENT(Required)

EXPERIENCE WITH THE FOLLOWING AGES:(Required)

	0	1	2	3	4	5
Newborn/Neonate (birth to 30 days)*
Infant (1 month to 1 year)*
Toddler (1 year to 3 years)*
Preschooler (3 years to 5 years)*
School Age Child (5 years to 12 years)*
Adolescents (12 years to 18 years)*
Young Adults (18 years to 39 years)*
Middle Adults (39 years to 64 years)*
Older Adults (64 years to 79 years)*
Elderly Adults (over 79+ years)*

MISCELLANEOUS(Required)

	0	1	2	3	4	5
Universal Protocol*
Crash Cart*
Patient Identification*
Hand-off Communication*
Standard Precautions*
Isolation Precautions*
Pediatric Respiratory/Cardiac Arrest*
Adult Respiratory/Cardiac Arrest*
Electronic Documentation*

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)

	0	1	2	3	4	5
Circumcision*
Cystoscopy/ Cystostomy*
Cystectomy*
Hypospadius Repair*
Ileal Loop*
Lithotripsy*
Nephrectomy*
Orchiectomy*
Penile Implant*
Prostatectomy*
Ureterolithotomy*
T.U.R.P./T.U.R.B*
Vasectomy*

	0	1	2	3	4	5
Anterior Cervical Fusion*
Burrholes for Subdural Hematoma*
Craniotomy*
Laminectomy*
Meningocele Repair*
Shunt Procedures- VP/ VA*

	0	1	2	3	4	5
Chest Tube Set- Up*
Hiatal Hernia*
Pneumonectomy/ Lobectomy*
Sternal Splitting*
Thoracotomy*
Bronchoscopy*
Lung/Wedge Resection*

	0	1	2	3	4	5
Robotics*
Fracture Tables*
Video Systems*
CUSA*
Cell Saver*
PACS Diagnostics*
Electrocautery*
Drills*
Saws*
Stapling Devices*
Cardiac Monitors*
Crash Carts*
Defibulators*

	0	1	2	3	4	5
Log*
Biological Indicators*
Autoclave Operation*
High Level*
STERIS*
Steam*
Gas*
Flash*

	0	1	2	3	4	5
Pancreas*
Heart*
Lung*
Liver*
Kidney*
Eye*