Endoscopy Skills Checklist
Answer Key
1. No Experience 2. Requires Supervision 3. Proficient 4. Can Teach Others
Procedures, Assist or Knowledge of
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Any thoughts?
Anoscopy
Bronchoscopy
Colonoscopy
EGD
ERCP
Flexible Sigmoidoscopy
IV Drip
Conscious Sedation Record
Rigid Protoscopy
Sphincterotomy
Accessory Equipment
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Cytology Brushes
Decompression Tubes
Dilators : Balloon
Dilators : Maloney
Dilators : Savory
Forceps
Foreign Body Equipment
Polyp Snares
Valley Lab BX
Bleeder Cart Equipment
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4
Bicap Unit
Code Blue Lavage Kit
Endo Pump
Esophageal Banding
Gold Probe/Injector Needle
Scero Needles and Meds
Gastro-Intestinal Feeding Tubes
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4
Jejunal feeding tube
Naso-Enteric Tube
Peg Insertion Equipment
Replacement Gastrostomy Buttons
Replacement Gastrostomy Tubes
ERCP
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3
4
Equipment and Stock
Papillatomy
Som Procedure
Stent Placement
Age Specific
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4
Newborn/Neonatal (up to 30 days)
Infant (30 days to 1 year)
Toddler (1 to 3 years)
Preschooler (3 to 5 years)
School Age (5 to 12 years)
Adolescents (12 to 18 years)
Young Adults (18 to 39 years)
Middle Adults (40 to 64 years)
Older Adults (65 & up)
Undertaking
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The Information I Provided is True & Accurate
Name
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Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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