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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AGE OF PATIENTS CARED FOR

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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)
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

BASIC CLINICAL SKILLS IN RADIOTHERAPY

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The Clinical Environment
Simulation
Clinical Conduct
Chart Checking
Record and Verify Systems
Basic Radiation Safety

QUALITY ASSURANCE IN RADIATION ONCOLOGY

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Linear Accelerator Quality Assurance
Acceptance Testing and Commissioning
Measurement Equipment QA
CT Simulator QA
Portal Imaging and kV X-Ray Imaging QA
Cone-Beam CT QA
PET-CT QA
HDR QA
Software Systems QA
Prevention of Technology-Related Errors

TREATMENT PLANNING

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Prerequisites for Treatment Planning
Mark and Start Cases
3D-Conformal Planning
IMRT Planning
Protocols
Secondary Monitor Unit (MU) Checks
Block Cutting
Diodes/TLD
Beam Data Collection, Modeling, and Commissioning

SPECIAL PROCEDURES

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Radiosurgery
LDR Brachytherapy
HDR Brachytherapy
TBI Electrons and Photons
IGRT Methods
Rotational Therapy
Proton Therapy

HEALTH PHYSICS

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Radiation Safety
Instrumentation for Health Physics Measurements
Shielding Calculations
Isotope Procedures

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 - Medical Physicist