Skills Checklist

This Skills Checklist is a self-evaluation to assess your recent experience in various clinical settings focusing on the past 2 years.

0 = No Experience
1 = Some Experience
2 = Intermittent Experience
3 = Experienced
4 = Very Experienced

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EXPERIENCE WITH AGES

Rows	0	1	2	3	4
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

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Standard Precautions
Isolation Precautions
Pediatric Respiratory/Cardiac Arrest
Adult Respiratory/Cardiac Arrest
Crash Carts
Defibrillators
Care of Patient in Restraints
Pain Management
Automated Med Dispensing Systems
Care Planning & Discharge Planning
Patient/Family Education
Electronic Documentation
Patient Head to Toe Assessment
Peripheral IV Insertion, Care and Maintenance

MEDICATIONS

Rows	0	1	2	3	4
Calculate mcg/min and mcg/kg/min
Titrating Medications
Isuprel
Adenosine
Amiodarone

ASSESSMENT AND MONITORING

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Lead Placement
Basic 12 Lead EKG Interpretation
Cardiac Rhythm Interpretation
Doppler
Blood Pressure Invasive and Noninvasive

HEMODYNAMIC MONITORING

Rows	0	1	2	3	4
Art Line
Swan Ganz
Waveform Assessment
General Lab work Interpretation
ABG Interpretation
Cardiac Enzyme Interpretation
Chemistry Interpretation

CARE AND MAINTENANCE

Rows	0	1	2	3	4
Central Venous Access Device
Arterial Line
Swan Ganz
IABP
Sheaths
Removal of Sheath
Manual Pressure Hold
C-Clamp
FemStop
VasoSeal, Angioseal, PerClose
Hematoma Recognition/Management

PROCEDURE EQUIPMENT

Rows	0	1	2	3	4
Scrub EP Procedures
Circulate EP Procedures
Monitor EP Procedures
Ablation (Atrial/Ventricular)
Velocity Mapping
Cart/ Mapping
Rhythmia Mapping
Bloom Stimulator
Micropace Ep-4
Diagnostic Catheters
Bi-V
Stereotaxis
AICD Placement
Bovie
PPM
Baylis
Temporary Pacemaker
Peak Plasma Blade
Cardioversion
Internal Cardioversion Catheters / AICD Testing
NIPS Procedure
Pericardiocentesis
Demonstrate Proper Preservations of Tissue Specimen for Lead Extractions
ACT Machine
Lead Extractions - Spectranetics laser
Device Implants
Ablation Equipment (ie: Stockert, Maestro, Cool Flow, Tactisys)

Position Category

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Total Years of Experience

First Name

Last Name

Social Security #

Date of Birth

Email

Phone

Attestation

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified, particularly within the last 2 years. I hereby authorize Alliant Personnel Resources (The Company) to collect, store, and release any information that I have provided in this Skills Checklist and/or any other documentation and information they have collected or that I have submitted in any form to its parent company(s), its subsidiaries, or other subcontractors/its service providers as it deems necessary in its business operations as well as to individuals and companies in relation to consideration of employment as a Healthcare Professional with those companies and individuals. I acknowledge that The Company will take precaution and care to protect my personal information that is collected/stored/shared but cannot guarantee permanent data security and I release The Company from all related liability for damages or punitive liability.

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Skills Checklist - EP Tech