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Medical Laboratory Technician Medical Technologist Phlebotomist Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided to FILL IN THE BLANK on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. | |||||||
| Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. | |||||||
| Proficiency Scale: |
1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently |
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| Rating Stars (Click) | WORK SETTINGS | 1 | 2 | 3 | 4 | ||
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Free Standing Lab | ||||||
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Reference Lab | ||||||
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Acute Setting | ||||||
| Rating Stars (Click) | BLOOD BANK | 1 | 2 | 3 | 4 | ||
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Patient Identification Process | ||||||
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ABO/Rh/Antibody Screen & ID | ||||||
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Crossmatch - Immediate Spin/IgG | ||||||
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Antigen Typing | ||||||
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Antibody Typing: Gel Method | ||||||
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Antibody Typing: Tub Method | ||||||
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Cold Agglutinins | ||||||
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Rhogam Screening | ||||||
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Cord Blood Evaluation | ||||||
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Thawing/Cooling of Blood Products | ||||||
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Donor Collection Procedures | ||||||
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Issue Blood Product to Pt. Care Area | ||||||
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Emergency Release | ||||||
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Transfusion Reaction Workup | ||||||
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Instrumentation (Specify) | ||||||
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Instrumentation (Specify) | ||||||
| Rating Stars (Click) | CHEMISTRY | 1 | 2 | 3 | 4 | ||
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Specimen Preparation | ||||||
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Acetone Analysis | ||||||
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Arterial Blood Gas | ||||||
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B -12 Folates | ||||||
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Cardiac Enzymes | ||||||
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Chromatography - Gas | ||||||
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Chromatography - Thin Layer | ||||||
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Electropheresis | ||||||
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Hormone/Thyroid | ||||||
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Immunoassay | ||||||
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Osmolality | ||||||
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Stool Analysis | ||||||
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Therapeutic Drug Monitoring | ||||||
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Tumor Markers | ||||||
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Analyzer Use/Troubleshooting | ||||||
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Review & Interpretation of QC | ||||||
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Instrumentation (Specify) | ||||||
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Instrumentation (Specify) | ||||||
| Rating Stars (Click) | HEMATOLOGY/COAGULATION | 1 | 2 | 3 | 4 | ||
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Automated Instrument Use | ||||||
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CBC Manual | ||||||
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Differential Manual | ||||||
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Sed Rate Manual | ||||||
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Reticulocyte Count | ||||||
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Fetal Hemoglobin | ||||||
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RBC Morphology | ||||||
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Platelet Count | ||||||
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Platelet Morphology | ||||||
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Body Fluid Analysis | ||||||
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Special Stains - e.g. PAS, LAP, Peroxidase | ||||||
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PT/PTT/INR | ||||||
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D-Dimer | ||||||
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Fibrinogen | ||||||
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Factor Assays | ||||||
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Fibrin Degradation Products | ||||||
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Thrombin Time | ||||||
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Platelet Function Analysis | ||||||
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Instrumentation (Specify) | ||||||
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Instrumentation (Specify) | ||||||
| Rating Stars (Click) | IMMUNOLOGY/SEROLOGY | 1 | 2 | 3 | 4 | ||
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RPR/RPR Titer | ||||||
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Rheumatoid Titer | ||||||
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ANA | ||||||
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LE Prep | ||||||
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HIV Rapid | ||||||
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HIV Antibody Detection | ||||||
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Rubella | ||||||
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CMV | ||||||
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Instrumentation (Specify) | ||||||
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Instrumentation (Specify) | ||||||
| Rating Stars (Click) | MICROBIOLOGY | 1 | 2 | 3 | 4 | ||
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Cultures | ||||||
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Sub Cultures | ||||||
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Sensitivities | ||||||
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Kit Testing - Monospot/ASO Titer | ||||||
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Kit Testing - Flu/Rapid Strep/RSV | ||||||
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Wet Prep/KOH Prep | ||||||
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AFB Stain/Culture | ||||||
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O&P | ||||||
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Chlamydia | ||||||
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Processing Specimens for Viral/Fungal Cultures | ||||||
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Vitek | ||||||
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Instrumentation (Specify) | ||||||
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Instrumentation (Specify) | ||||||
| Rating Stars (Click) | URINALYSIS | 1 | 2 | 3 | 4 | ||
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Crystal Identification | ||||||
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Macroscopic Analysis | ||||||
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Microscopic Analysis | ||||||
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Pregnancy Testing | ||||||
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Instrumentation (Specify) | ||||||
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Instrumentation (Specify) | ||||||
| Rating Stars (Click) | PHLEBOTOMY | 1 | 2 | 3 | 4 | ||
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Patient Identification | ||||||
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PPE Equipment (Gloves/Mask, etc.) | ||||||
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Adult Venipuncture | ||||||
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Pediatric Venipuncture | ||||||
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Dermal Stick (Finger/Heel) | ||||||
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Butterfly Draw | ||||||
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Arterial Draw | ||||||
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Tube Types and Usage | ||||||
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Centrifuge Operation | ||||||
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Bleeding Time | ||||||
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Blood Culture Collection | ||||||
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Blood Alcohol Collection | ||||||
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Drug Screening Collection | ||||||
| Rating Stars (Click) | GENERAL EQUIPMENT | 1 | 2 | 3 | 4 | ||
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Beckman | ||||||
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Hitachi | ||||||
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Ortho Vitros | ||||||
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Roche | ||||||
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Other: Specify | ||||||
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Other: Specify | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Infant (Birth - 1 year) | ||||||
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Preschooler (ages 2-5 years) | ||||||
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Childhood (ages 6-12 years) | ||||||
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Adolescents (ages 13-21 years) | ||||||
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Young Adults (ages 22-39 years) | ||||||
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Adults (ages 40-64 years) | ||||||
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Older Adults (ages 65-79 years) | ||||||
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Elderly (ages 80+ years) | ||||||
| Rating Stars (Click) | LAB INFORMATION SYSTEMS | 1 | 2 | 3 | 4 | ||
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Meditech | ||||||
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Cerner | ||||||
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Horizon | ||||||
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Sunquest | ||||||
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Orchard | ||||||
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Other: Specify | ||||||
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Other: Specify | ||||||