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1.877.891.4286
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Surgical Tech RN – Skills Checklist
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 Precision Nationwide Staffing.
0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced
General Surgery
Abdominal Perineal Resection
*
0
1
2
3
4
5
Adrenalectomy
*
0
1
2
3
4
5
Bowel Resection
*
0
1
2
3
4
5
Cholecystectomy
*
0
1
2
3
4
5
Colostomy/Ileostomy
*
0
1
2
3
4
5
Gastrectomy
*
0
1
2
3
4
5
Hemicolectomy
*
0
1
2
3
4
5
Hepatic Resection
*
0
1
2
3
4
5
Herniorrhaphy - Femoral/Inguinal
*
0
1
2
3
4
5
Hiatal Herniorrhaphy - Transabdominal
*
0
1
2
3
4
5
Pancreatectomy
*
0
1
2
3
4
5
Organ Procurement
*
0
1
2
3
4
5
Radical Mastectomy
*
0
1
2
3
4
5
Saphenous Vein Ligation and Stripping
*
0
1
2
3
4
5
Splenectomy
*
0
1
2
3
4
5
Thyroidectomy
*
0
1
2
3
4
5
Tracheostomy
*
0
1
2
3
4
5
Whipple Procedure
*
0
1
2
3
4
5
Laparoscopic Procedures
Hysterectomy
*
0
1
2
3
4
5
Cholecystectomy
*
0
1
2
3
4
5
Appendectomy
*
0
1
2
3
4
5
Hernia Repair
*
0
1
2
3
4
5
Colon Resection
*
0
1
2
3
4
5
Gynecology
Caesarean Section
*
0
1
2
3
4
5
Dilation & Curettage
*
0
1
2
3
4
5
Hysterectomy - Vaginal
*
0
1
2
3
4
5
Hysterectomy - Abdominal
*
0
1
2
3
4
5
Laser Surgery
*
0
1
2
3
4
5
Radium Insertion
*
0
1
2
3
4
5
Salpingo - Oopherectomy
*
0
1
2
3
4
5
Shirodkar Procedure
*
0
1
2
3
4
5
Termination of Pregnancy
*
0
1
2
3
4
5
Tubal Ligation
*
0
1
2
3
4
5
Vaginectomy
*
0
1
2
3
4
5
Vaginal Reconstruction
*
0
1
2
3
4
5
G.U. And Cysto
Circumcision
*
0
1
2
3
4
5
Cystoscopy/Cystostomy
*
0
1
2
3
4
5
Cystectomy
*
0
1
2
3
4
5
Hypospadius Repair
*
0
1
2
3
4
5
Ileal Loop
*
0
1
2
3
4
5
Lithotripsy
*
0
1
2
3
4
5
Nephrectomy
*
0
1
2
3
4
5
Orchiectomy
*
0
1
2
3
4
5
Penile Implant
*
0
1
2
3
4
5
Prostatectomy
*
0
1
2
3
4
5
Ureterolithotomy
*
0
1
2
3
4
5
T.U.R.P./T.U.R.B.
*
0
1
2
3
4
5
Vasectomy
*
0
1
2
3
4
5
Orthopedic
Amputation - Leg/Arm
*
0
1
2
3
4
5
Application of Halo Traction
*
0
1
2
3
4
5
Arthroscopy/Arthrotomy
*
0
1
2
3
4
5
Closed Pinning & Reduction of Extremities
*
0
1
2
3
4
5
External Compression Devices
*
0
1
2
3
4
5
Insertion of Finger Prosthesis
*
0
1
2
3
4
5
Total Joint Replacement - Knee, Hip, Shoulder
*
0
1
2
3
4
5
Spinal Fusion - Harrington Rods
*
0
1
2
3
4
5
Spica Cast Application
*
0
1
2
3
4
5
O.R.I.F. - Shoulder, Hip, Humerus, etc.
*
0
1
2
3
4
5
Repair of Dislocation
*
0
1
2
3
4
5
Patellectomy
*
0
1
2
3
4
5
Tendon Implants & Reanastomosis
*
0
1
2
3
4
5
Neurosurgery
Anterior Cervical Fusion
*
0
1
2
3
4
5
Burrholes for Subdural Hmatoma
*
0
1
2
3
4
5
Craniotomy
*
0
1
2
3
4
5
Laminectomy
*
0
1
2
3
4
5
Meningocele Repair
*
0
1
2
3
4
5
Shunt Procedures - VP/VA
*
0
1
2
3
4
5
Plastics
Face Lift
*
0
1
2
3
4
5
Skin Grafting
*
0
1
2
3
4
5
Abdominoplasty/Abdominal Lipectomy
*
0
1
2
3
4
5
Augmentation Mammoplasty
*
0
1
2
3
4
5
Cleft Lip/Palate Repair
*
0
1
2
3
4
5
Dermabrasion
*
0
1
2
3
4
5
Digital Flexor Tendon Repair
*
0
1
2
3
4
5
Liposuction
*
0
1
2
3
4
5
Myelomeningocele Repair
*
0
1
2
3
4
5
Otoplasty
*
0
1
2
3
4
5
Rhinoplasty
*
0
1
2
3
4
5
Rhinoplasty
*
0
1
2
3
4
5
Eye
Excision of Chalazion
*
0
1
2
3
4
5
Canthotomy
*
0
1
2
3
4
5
Correction of Ectropian/Entropian
*
0
1
2
3
4
5
Corneal Transplant
*
0
1
2
3
4
5
Enucleation
*
0
1
2
3
4
5
I.O.I. Implants
*
0
1
2
3
4
5
Lacrimal Duct Probing
*
0
1
2
3
4
5
Refractive Keratoplasty
*
0
1
2
3
4
5
Repair of Retinal Detachment
*
0
1
2
3
4
5
Vitrectomy
*
0
1
2
3
4
5
Ear, Nose, & Throat
Caldwell-Luc
*
0
1
2
3
4
5
Ethymoidectomy
*
0
1
2
3
4
5
Frontal Flap Sinus Procedure
*
0
1
2
3
4
5
Laryngectomy
*
0
1
2
3
4
5
Open Reduction Facial Fractures
*
0
1
2
3
4
5
Radical Neck
*
0
1
2
3
4
5
Tonsillectomy & Adenoidectomy
*
0
1
2
3
4
5
Myringotomy
*
0
1
2
3
4
5
Mastoidectomy
*
0
1
2
3
4
5
Tympanoplasty
*
0
1
2
3
4
5
Stapedectomy
*
0
1
2
3
4
5
Nasal Polypectomy
*
0
1
2
3
4
5
Laryngoscopy
*
0
1
2
3
4
5
Thoracic
Chest Tube Set-Up
*
0
1
2
3
4
5
Hiatal Hernia
*
0
1
2
3
4
5
Pneumonectomy/Lobectomy
*
0
1
2
3
4
5
Sternal Splitting
*
0
1
2
3
4
5
Thoracotomy
*
0
1
2
3
4
5
Bronchoscopy
*
0
1
2
3
4
5
Lung/Wedge Resection
*
0
1
2
3
4
5
Endoscopy
Bronchoscopy
*
0
1
2
3
4
5
Cystoscopy
*
0
1
2
3
4
5
Gastroscopy
*
0
1
2
3
4
5
Colonoscopy
*
0
1
2
3
4
5
Cardiovascular
A-V Shunts
*
0
1
2
3
4
5
Aortic Aneurysm, Abdominal
*
0
1
2
3
4
5
Aorto-Femoral Bypass
*
0
1
2
3
4
5
Graft Insertion
*
0
1
2
3
4
5
Cardiac Valve Replacement
*
0
1
2
3
4
5
Coronary Artery Bypass Graft-on Pump
*
0
1
2
3
4
5
Endarterectomy-Cardtid/Femoral
*
0
1
2
3
4
5
Femoral - Popliteal Bypass
*
0
1
2
3
4
5
External Temporary Pacemaker
*
0
1
2
3
4
5
Internal Pacemaker Insertion
*
0
1
2
3
4
5
Intra-Aortic Balloon Pump Catheter
*
0
1
2
3
4
5
Patent Ductus Repair
*
0
1
2
3
4
5
Pericardial Windows
*
0
1
2
3
4
5
Repair of Septal Defects
*
0
1
2
3
4
5
Thrombectomy
*
0
1
2
3
4
5
Vena Cava Ligation
*
0
1
2
3
4
5
Transplants
Pancreas
*
0
1
2
3
4
5
Heart
*
0
1
2
3
4
5
Lung
*
0
1
2
3
4
5
Liver
*
0
1
2
3
4
5
Kidney
*
0
1
2
3
4
5
Eye
*
0
1
2
3
4
5
Equipment
Robotics
*
0
1
2
3
4
5
Robotics - List Types
*
Fracture Tables
*
0
1
2
3
4
5
Fracture Tables - List Types
*
Video Systems
*
0
1
2
3
4
5
Video Systems - List Types
*
CUSA
*
0
1
2
3
4
5
Cell Saver
*
0
1
2
3
4
5
PACS Diagnostics
*
0
1
2
3
4
5
Electrocautery
*
0
1
2
3
4
5
Electrocautery - List Types
*
Drills
*
0
1
2
3
4
5
Drills - List Types
*
Saws
*
0
1
2
3
4
5
Saws - List Types
*
Stapling Devices
*
0
1
2
3
4
5
Stapling Devices - List Types
*
Cardiac Monitors
*
0
1
2
3
4
5
Cardiac Monitors - List Types
*
Crash Carts
*
0
1
2
3
4
5
Crash Carts - List Types
*
Defibulators
*
0
1
2
3
4
5
Defibulators - List Types
*
Sterilization of Equipment
Log
*
0
1
2
3
4
5
Biological Indicators
*
0
1
2
3
4
5
Autoclave Operation
*
0
1
2
3
4
5
High Level
*
0
1
2
3
4
5
STERIS
*
0
1
2
3
4
5
Steam
*
0
1
2
3
4
5
Gas
*
0
1
2
3
4
5
Flash
*
0
1
2
3
4
5
Miscellaneous
Universal Protocol
*
0
1
2
3
4
5
Crash Cart
*
0
1
2
3
4
5
Patient Identification
*
0
1
2
3
4
5
Hand-off Communication
*
0
1
2
3
4
5
Standard Precautions
*
0
1
2
3
4
5
Isolation Precautions
*
0
1
2
3
4
5
Pediatric Respiratory/Cardiac Arrest
*
0
1
2
3
4
5
Adult Respiratory/Cardiac Arrest
*
0
1
2
3
4
5
Electronic Documentation
*
0
1
2
3
4
5
Electronic Documentation - List Types
*
Experience with the Following Ages:
Newborn/Neonate (birth - 30 days)
*
0
1
2
3
4
5
Infant (30 days - 1 year)
*
0
1
2
3
4
5
Toddler (1 - 3 years)
*
0
1
2
3
4
5
Preschooler (3 - 5 years)
*
0
1
2
3
4
5
School Age Child (5 - 12 years)
*
0
1
2
3
4
5
Adolescents (12 - 18 years)
*
0
1
2
3
4
5
Young Adults (18 - 39 years)
*
0
1
2
3
4
5
Middle Adults (39 - 64 years)
*
0
1
2
3
4
5
Older Adults (64 - 79 years)
*
0
1
2
3
4
5
Elderly Adults (over 79+ years)
*
0
1
2
3
4
5
Information & Agreement
Application ID
*
Please enter your application ID. This ID should be 15 characters long and have the format of PHNMS##########. You should have received an email containing your application ID when you submitted your initial application. If not, please contact our staff.
Applicant Name
*
First
Last
Applicant Email
*
Applicant Phone
*
I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.
*
I agree to the terms below.
The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Precision Nationwide Staffing. Submit this skills evaluation with your initial application. To be updated annually.
Signature
*