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Skills Checklist

OB Tech

Let’s assess your clinical skills and experience. Fill out this checklist to get one step closer to your next opportunity.

1 = No theory and/or experience 2 = Limited Experience 3 = Experienced/minimal support needed to perform 4 = Proficient

AGE OF PATIENTS CARED FOR
Adolescents (12 years to 18 years)**
- 1
- 2
- 3
- 4
Young Adults (18 years to 39 years)**
- 1
- 2
- 3
- 4
Middle Adults (39 years to 64 years)**
- 1
- 2
- 3
- 4
Older Adults (64 years to 79 years)* 0 1 2 3 4 5*
- 1
- 2
- 3
- 4
Older Adults (64 years to 79 years)* 0 1 2 3 4 5*
- 1
- 2
- 3
- 4
General Skills
Universal Protocol**
- 1
- 2
- 3
- 4
Crash Cart/Defibrillator**
- 1
- 2
- 3
- 4
Patient Identification*
- 1
- 2
- 3
- 4
Hand-off Communication*
- 1
- 2
- 3
- 4
Standard Precautions*
- 1
- 2
- 3
- 4
Isolation Precautions*
- 1
- 2
- 3
- 4
Respiratory/Cardiac Arrest*
- 1
- 2
- 3
- 4
OB/GYNECOLOGY
Cesarean Section*
- 1
- 2
- 3
- 4
Dilation & Curettage*
- 1
- 2
- 3
- 4
Hysterectomy - Vaginal*
- 1
- 2
- 3
- 4
Hysterectomy - Laparoscopic*
- 1
- 2
- 3
- 4
Laser Surgery*
- 1
- 2
- 3
- 4
Radium Insertion*
- 1
- 2
- 3
- 4
Salpingo- Oopherectomy*
- 1
- 2
- 3
- 4
Shirodkar Procedure*
- 1
- 2
- 3
- 4
Termination of Pregnancy*
- 1
- 2
- 3
- 4
Tubal Ligation*
- 1
- 2
- 3
- 4
Vaginectomy*
- 1
- 2
- 3
- 4
Vaginal Reconstruction*
- 1
- 2
- 3
- 4
EQUIPMENT
Robotics*
- 1
- 2
- 3
- 4
List Types:
Electocautery*
- 1
- 2
- 3
- 4
List Types:
STERILIZATION OF EQUIPMENT
Log*
- 1
- 2
- 3
- 4
Biological Indicators*
- 1
- 2
- 3
- 4
Autoclave Operation*
- 1
- 2
- 3
- 4
High Level*
- 1
- 2
- 3
- 4
STERIS*
- 1
- 2
- 3
- 4
Steam*
- 1
- 2
- 3
- 4
Gas*
- 1
- 2
- 3
- 4
Flash*
- 1
- 2
- 3
- 4
Please list the EMR systems you have used*
*
I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.*
OB Tech*
I hereby consent to allow CrossMed Healthcare Staffing Solutions to release these skills checklist to the client facilities.*
Your Recruiter*
Name*
First Last
Email*
Phone*
TODAY'S DATE*
MM slash DD slash YYYY

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