Medical Team Skills Assessment

Your Name *

First Name Last Name
E-mail *
example@example.com
Phone Number *

Area Code Phone Number
Best days, times, and methods to contact you? *
When would you be available to start at this new position? *
Would you prefer part time, full time, or either? Do you have any scheduling conflicts we should be aware of? *
When would you be available to start at this new position? *

Month Day Year
Date
Tech Assistant Skills Assessement:

Please use the following 1-5 scale to answer your confidence in the following skills.
1. I have never performed this task.
2. I have done this before, but need to be retrained.
3. I can mostly this, but I might need a refresher.
4. I can confidently perform this skill.
5. I could confidently train someone else on how to perform this task.

Restraining a dog for procedures (vaccines, blood draws, etc). *

	1	2	3	4	5

1 is , 5 is

Restraining a cat for procedures (vaccines, blood draws, etc). *

	1	2	3	4	5

1 is , 5 is

Removing a dog safely from a kennel and walking. *

	1	2	3	4	5

1 is , 5 is

Filling prescriptions, knowing how to interpret quantity, refills, and dosing instructions. *

	1	2	3	4	5

1 is , 5 is

Tech Level 1 Skills Assessement:

Please use the following 1-5 scale to answer your confidence in the following skills.
1. I have never performed this task.
2. I have done this before, but need to be retrained.
3. I can mostly this, but I might need a refresher.
4. I can confidently perform this skill.
5. I could confidently train someone else on how to perform this task.

Administer a SQ injection to a dog or a cat. *

	1	2	3	4	5

1 is , 5 is

Administer an IM injection to a dog or a cat. *

	1	2	3	4	5

1 is , 5 is

Obtain a blood sample from the cephalic vein of a dog. *

	1	2	3	4	5

1 is , 5 is

Obtain a blood sample from the medial saphenous vein of a cat. *

	1	2	3	4	5

1 is , 5 is

Obtain a blood sample from the jugular vein of a dog or cat. *

	1	2	3	4	5

1 is , 5 is

Talking to clients about rabies, distemper/parvo, lepto, and feline distemper vaccinations. *

	1	2	3	4	5

1 is , 5 is

Tech Level 2 Skills Assessement:

Please use the following 1-5 scale to answer your confidence in the following skills.
1. I have never performed this task.
2. I have done this before, but need to be retrained.
3. I can mostly this, but I might need a refresher.
4. I can confidently perform this skill.
5. I could confidently train someone else on how to perform this task.

Placing an IV Catheter in a Dog. *

	1	2	3	4	5

1 is , 5 is

Placing an IV Catheter in a Cat. *

	1	2	3	4	5

1 is , 5 is

Taking Xrays of the thorax or abdomen in a cat or dog. *

	1	2	3	4	5

1 is , 5 is

Scaling the teeth of a cat or dog. *

	1	2	3	4	5

1 is , 5 is

Tech Level 3 Skills Assessement:

Please use the following 1-5 scale to answer your confidence in the following skills.
1. I have never performed this task.
2. I have done this before, but need to be retrained.
3. I can mostly this, but I might need a refresher.
4. I can confidently perform this skill.
5. I could confidently train someone else on how to perform this task.

Taking dental xrays of a cat or dog. *

	1	2	3	4	5

1 is , 5 is

Intubating a cat or dog. *

	1	2	3	4	5

1 is , 5 is

Monitoring Anesthesia *

	1	2	3	4	5

1 is , 5 is

Inducing Anesthesia *

	1	2	3	4	5

1 is , 5 is

Recognizing normal from abnormal EKG patterns. *

	1	2	3	4	5

1 is , 5 is

Prior Work Experience:
Describe your previous veterinary related work experience. How long did you work there? Why did you leave? *
For which position would you ideally apply? *

Vet Tech Assistant Vet Tech Level 1 Vet Tech Level 2 Vet Tech Level 3
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