Skill Checklists

Operating Room Surgical Technologist

This checklist was electronically signed on (Today’s date)

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

  • 1 = No Experience

  • 2 = Need Training

  • 3 = Able to perform with supervision

  • 4 = Able to perform independently

General Surgery

Abdominal Perineal Resection

Appendectomy/Cholescystectomy

Breast Biopsy

Colon Resection/Surgery

Gastrectomy

Gastric Bypass/Roux-en-Y

Herniorrhaphy - Inguinal, Ventral, Femoral, Umbilical

Laparoscopic General Surgeries

Laparoscopic Nissen Fundoplication

Mastectomy

Splenectomy

Thyroidectomy

Cardiovascular

Aorta Repair

Aorto-Bifemoral/Femoral-Pop Bypass Graft

Cardiac Bypass Surgery

Carotid Endarterectomy

Endoscopic Vascular Procedures

Femoral Popliteal Bypass Graft

Laparascopic Cardiac Surgery

Robotic Assisted Cardiac Surgery

Valve Replacement/Repair

Ventricular Assist Device

Thoracic

Endoscopic Thoracic Procedures

Esophagogastrectomy

Mediastinotomy/Sternotomy

Thoracoscopy/Nuss Procedure

Thoracotomy

Orthopedic

Total Joint Replacement

Closed Reduction of Fracture

External Fixator

Cannulated Hip Screws

Bankhart Procedure

Birmingham Procedure

Carpal Tunnel Release

Arthroscopy

Anterior Cruciate Ligament Reconstruction

NEUROLOGICAL

Craniotomy

Steriotactic Guided Brain Biopsy

Laminectomy

Laparoscopic Anterior Laminectomy

Insertion of Vagal Nerve Stimulator

Insertion of VP Shunt

Spinal Fusion

Anterior Cervical Discectomy with Fusion

Posterior Cervical Laminectomy

Genitourinary

Vasicaurethropexy

Marshall Marchetti

Circumcision

Cystoscopy/Cystogram/Pyelogram

Prostatectomy

Nephrectomy

Orchidectomy/Orchidopexy

Ureterostomy

Laparoscopic Assisted GU Procedures

Robotic Assisted GU Procedures

Gynecological

Abdominal Hysterectomy

Anterior Posterior Repair

C-Section

D & C

Laparoscopic Assisted Hysterectomy

Robotic Assisted GYN Procedures

Vaginal Delivery

Vaginal Hysterectomy

Ear/ Nose / Throat

Endoscopic ENT Procedures

Laryngectomy

Mastoidectomy

Myringotomy with Insertion of Tubes

Radical Neck

Septoplasty

Tonsillectomy & Adenoidectomy

Tympanoplasty

Craniofacial/ Oral / Plastics

Craniectomy

Craniofacial Reconstruction

Dental Surgery

Leforte 1 Maxillary/Sagittal Osteotomy

ORIF Mandibular Fracture

Otoplasty

Reconstruction of Ear

Removal of Arch Bars

Repair of Cleft Lip, Nose, Palate

Rhinoplasty

Plastics

Blephoroplasty

Breast Reconstruction with Implant

Breast Reduction Mammoplasty

Face Lift

Mastectomy with Tram Flap Reconstruction

Split Thickness Skin Graft

Suction Lipectomy

TRANSPLANTS

Heart

Lung

Liver

Pancreas

Eye

Organ Donation

OPHTHAMOLOGY

Cataract Extraction with Implant

Vitrectomy

Scleral Buckle

Cataract Aspiration; Anterior Vitrectomy

Corneal Transplant

General Surgery

Anal Fistulectomy/Anoplasty

Appendectomy/Cholecystectomy

Biopsy (Mass, Muscle, Lymph Node)

Bronchoscopy

Colostomy

Esophagogastroduodenoscopy w/ Biopsy

Esophagoscopy

Exploratory Laparotomy

Flexible Sigmoidoscopy

Fundoplication

Gastrostomy

Herniorrhaphy

Insertion of Port-a-Cath, Hickman, Broviac

Laparascopic General Surgery Procedures

Liver Biopsy

Percutaneous Endoscopic Gastrostomy

Thoracoscopy/Nuss Procedure

Genitourinary

Circumcision

Cystoscopy/Cystogram/Pyelogram

Hydrocelectomy

Nephrectomy

Orchidectomy/Orchidopexy

Repair of Hypospadias

Retrograde Pyelogram

Ureterostomy

Neuro

Craniotomy

Insertion of Vagal Nerve Stimulator

Insertion of VP Shunt

Laminectomy

Cardiac / Vascular

Arterial Switch

ASD/VSD Repair

Atrial Septectomy

Bidirectional Glenn

BT Shunt

ECMO Insertion/Decannulation

Fontan Procedure

Norwood Procedure

Pacemaker

PDA Ligation

Repair of Coarctation of Aorta

Ross Procedure

Tetralogy of Fallot Repair

Valve Repair/Replacement

Ventricular Assist Device

Transplants

Heart

Kidney

Liver/Pancreas

Lung

Organ Donation

Ophthamalogy

Corneal Transplant

Dacrocystorhinostomy

Excision of Chalazion

Eye Muscle Surgery

Levator Resection

Orbitotomy of Eye

Repair of Ptosis

OR EQUIPMENT

Electrocautery (ESU)

Neuro

Laparoscopy Systems

OR Fracture Tables (List types below)

OR EQUIPMENT - List Types

Orthopedic Total Joint Systems

Power Equipment

Robotics Systems

Spinal Fusion Instrumentation

Professional Knowledge and Skills

Malignant Hyperthermia Protocol

Infection Prevention

Isolation Precautions

National Patient Safety Goals/Core Measures

Universal Protocol

EMR

Epic

Picis

Cerner

Eclipsys

McKesson

Meditech

Other Computerized System

Computerized Physician Order Entry

EMR Conversion - yes

Certifications

BLS

Certified Surgical Technologist (CST)

Certified Sterile Processing Technologist (CSPT)

Other: Specify

Age Specific Competencies

Infant (Birth - 1 year)

Preschooler (ages 2-5 years)

Childhood (ages 6-12 years)

Adolescents (ages 13-21 years)

Young Adults (ages 22-39 years)

Adults (ages 40-64 years)

Older Adults (ages 65-79 years)

Elderly (ages 80+ years)

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.