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
Abdominal
Pancreas
Liver
Pelvis
Temporomandibular
Adrenal
Aorta
Thorax
Brain CT Scans Contrast Non-contrast
Chest
Orbit
Pulmonary embolism
Internal Auditory canal
Facial Bone
Sinus
Mastoid Scan
Neck Scans
Thoracic Scans
Cervical Spines
Lumbar/Sacral Spine Scans
Post Myelogram scans
Trauma Spinal scans
Upper extremity scans
Lower extremity scans
Renal cyst puncture
Spin-echo images
Surface coils
Biopsy procedures
Gradient Echo imaging
Guided Thoracic drainage’s, abdominal drainages.
Pediatric Head Scans
Pediatric thoracic and abdominal Scans
Quality improvement studies/participation
Siemens
Tesla
Philips
Hewlett Packard
Badge/ PPE
Kodak Processor
General Electric
Hitachi
Other
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)
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