• Interventional Radiology Skills Checklist

  • Answer Key:

    1. No Experience

    2. Limited Experience

    3. Experienced

    4. Very Experienced

  • General Skills
    Rows
  • Knowledge And Use Of:
    Rows
  • Administration of Blood/Blood Products
    Rows
  • Circulate- Assist with Insertion/Removal/Repair of:
    Rows
  • Scrub- Assist With Insertion/Removal/Repair of:
    Rows
  • Circulate The Following Procedures
    Rows
  • Scrub The Following Procedures
    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: