• OR Tech Skills Checklist

     

  • Answer Key:

    1. No Experience

    2. Limited Experience

    3. Experienced

    4. Very Experienced

  • General Surgery
    Rows
  • Cardiovascular
    Rows
  • Thoracic
    Rows
  • Orthopedic
    Rows
  • Neurological
    Rows
  • Genitourinary
    Rows
  • Gynecological
    Rows
  • Ear/Nose/Throat
    Rows
  • Craniofacial/Oral/Plastics
    Rows
  • Plastic
    Rows
  • Transplants
    Rows
  • Equipment
    Rows
  • Other Skills
    Rows
  • Age Specific
    Rows
  • I attest that this checklist represents a true reflection of my experience to the best of my knowledge.  By electronically signing this form I give my permission for it to be shared with facilities as a way to assess my skill level and be considered for employment opportunities.  

  •  -
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: