Skill Checklists

Polysomnographer/Sleep Tech

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

AGE OF PATIENTS CARED FOR *

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)

GENERAL SKILLS *

Standard Precautions

Isolation Precautions

Pediatric Respiratory/Cardiac Arrest

Adult Respiratory/Cardiac Arrest

Crash Carts

Defibrillators

Electronic Documentation

Automated Med Dispensing Systems

SETTING *

Hospital

Independent Lab

Patient Home

MONITOR SCORING *

Periodic Limb Movements

Snores

Respiratory Events

Respiratory Disturbance Index (RDI)

Apnea-Hypopnea Index (AHI)

Periodic Breathing

Complex Sleep Apnea

Cheyne-Stokes

Obstructive Sleep Apnea

Hypopnea

Sleep Log

Seizure Recognition and Precaution

Transient Arousal Scoring Rules/Procedures

DIAGNOSTIC STUDIES/PROCEDURES *

Multiple Sleep Latency Test (MSLT)

Maintenance of Wakefulness Test (MWT)

Nocturnal Penile Tumescence

Seizure Study

Portable Sleep Study

Split-Night Polysomnogram

EKG Electrode Placement

EEG Electrode Placement

Seizure Hook-Up

Calibration

Patient Positioning/Preparation

Drawing Arterial Blood Gases (ABGs)

CREDENTIALS *

CPSGT

RST

RPSGT

SDS

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.