Certified Surgical First Assist Skills Checklist

Skills Checklist

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
Newborn/Neonate (birth to 30 days)*
- 1
- 2
- 3
- 4
Infant (1 month to 1 year)*
- 1
- 2
- 3
- 4
Toddler (1 year to 3 years)*
- 1
- 2
- 3
- 4
Preschooler (3 years to 5 years)*
- 1
- 2
- 3
- 4
School Age Child (5 years to 12 years)*
- 1
- 2
- 3
- 4
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)*
- 1
- 2
- 3
- 4
Elderly Adults (over 79+ years)*
- 1
- 2
- 3
- 4
Miscellaneous
Adult Respiratory/ Cardiac Arrest*
- 1
- 2
- 3
- 4
Autoclave*
- 1
- 2
- 3
- 4
Automated Med Dispensing Systems*
- 1
- 2
- 3
- 4
List Type:
Care of Scopes & Fiberoptic Equipment*
- 1
- 2
- 3
- 4
Cidex Soap*
- 1
- 2
- 3
- 4
Crash Cart*
- 1
- 2
- 3
- 4
Defibrillator*
- 1
- 2
- 3
- 4
Electronic Documentation*
- 1
- 2
- 3
- 4
List Types:
Hand-off Communication*
- 1
- 2
- 3
- 4
Isolation Precautions*
- 1
- 2
- 3
- 4
Patient Identification*
- 1
- 2
- 3
- 4
Pediatric Respiratory/ Cardiac Arrest*
- 1
- 2
- 3
- 4
Standard Precautions*
- 1
- 2
- 3
- 4
Universal Protocol*
- 1
- 2
- 3
- 4
General Surgery
Abdominal Perineal Resection*
- 1
- 2
- 3
- 4
Adrenalectomy*
- 1
- 2
- 3
- 4
Bowel Resection*
- 1
- 2
- 3
- 4
Cholecystectomy*
- 1
- 2
- 3
- 4
Colostomy/Ileostomy*
- 1
- 2
- 3
- 4
Gastrectomy*
- 1
- 2
- 3
- 4
Hemicolectomy*
- 1
- 2
- 3
- 4
Hepatic Resection*
- 1
- 2
- 3
- 4
Herniorrhaphy-Femoral/ Inguinal*
- 1
- 2
- 3
- 4
Hiatal Herniorrhaphy- Transabdominal*
- 1
- 2
- 3
- 4
Pancreatectomy*
- 1
- 2
- 3
- 4
Organ Procurement*
- 1
- 2
- 3
- 4
Radical Mastectomy*
- 1
- 2
- 3
- 4
Saphenous Vein Ligation and Stripping*
- 1
- 2
- 3
- 4
Splenectomy*
- 1
- 2
- 3
- 4
Thyroidectomy*
- 1
- 2
- 3
- 4
Tracheostomy*
- 1
- 2
- 3
- 4
Whipple Procedure*
- 1
- 2
- 3
- 4
Laparoscopic Procedures
Hysterectomy*
- 1
- 2
- 3
- 4
Cholecystectomy*
- 1
- 2
- 3
- 4
Appendectomy*
- 1
- 2
- 3
- 4
Hernia Repair*
- 1
- 2
- 3
- 4
Colon Resection*
- 1
- 2
- 3
- 4
Gynecology
Caesarean Section*
- 1
- 2
- 3
- 4
Dilation & Curettage*
- 1
- 2
- 3
- 4
Hysterectomy-Vaginal*
- 1
- 2
- 3
- 4
Hysterectomy-Abdominal*
- 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
G.U. and CYSTO
Circumcision*
- 1
- 2
- 3
- 4
Cystoscopy/ Cystostomy*
- 1
- 2
- 3
- 4
Cystectomy*
- 1
- 2
- 3
- 4
Hypospadius Repair*
- 1
- 2
- 3
- 4
Ileal Loop*
- 1
- 2
- 3
- 4
Lithotripsy*
- 1
- 2
- 3
- 4
Nephrectomy*
- 1
- 2
- 3
- 4
Orchiectomy*
- 1
- 2
- 3
- 4
Penile Implant*
- 1
- 2
- 3
- 4
Prostatectomy*
- 1
- 2
- 3
- 4
Ureterolithotomy*
- 1
- 2
- 3
- 4
Ureteroscopy*
- 1
- 2
- 3
- 4
T.U.R.P./T.U.R.B*
- 1
- 2
- 3
- 4
Vasectomy*
- 1
- 2
- 3
- 4
Orthopedic
Amputation- Leg/ Arm*
- 1
- 2
- 3
- 4
Application of Halo Traction*
- 1
- 2
- 3
- 4
Arthroscopy/ Arthrotomy*
- 1
- 2
- 3
- 4
Closed Pinning & Reduction of Extremities*
- 1
- 2
- 3
- 4
External Compression Devices*
- 1
- 2
- 3
- 4
Insertion of Finger Prosthesis*
- 1
- 2
- 3
- 4
Total Joint Replacement- Knee, Hip, Shoulder*
- 1
- 2
- 3
- 4
Spinal Fusion-Harrington Rods*
- 1
- 2
- 3
- 4
Spica Cast Application*
- 1
- 2
- 3
- 4
O.R.I.F.-Shoulder, Hip, Humerus, etc.*
- 1
- 2
- 3
- 4
Repair of Dislocation*
- 1
- 2
- 3
- 4
Patellectomy*
- 1
- 2
- 3
- 4
Tendon Implants & Reanastomosis*
- 1
- 2
- 3
- 4
Neurosurgery
Anterior Cervical Fusion*
- 1
- 2
- 3
- 4
AV Malformation*
- 1
- 2
- 3
- 4
Burrholes for Subdural Hematoma*
- 1
- 2
- 3
- 4
Craniotomy*
- 1
- 2
- 3
- 4
Discectomy/ Laminectomy*
- 1
- 2
- 3
- 4
Laminectomy*
- 1
- 2
- 3
- 4
Meningocele Repair*
- 1
- 2
- 3
- 4
Nerve Stimulators*
- 1
- 2
- 3
- 4
Shunt Procedures- VP/ VA*
- 1
- 2
- 3
- 4
Spinal Procedures/ Fusions*
- 1
- 2
- 3
- 4
Plastics
Abdominoplasty/Abdominal Lipectomy*
- 1
- 2
- 3
- 4
Augmentation Mammoplasty*
- 1
- 2
- 3
- 4
Breast Reduction/ Reconstruction*
- 1
- 2
- 3
- 4
Cleft Lip/Palate Repair*
- 1
- 2
- 3
- 4
Dermabrasion*
- 1
- 2
- 3
- 4
Digital Flexor Tendon Repair*
- 1
- 2
- 3
- 4
Face Lift*
- 1
- 2
- 3
- 4
Liposuction*
- 1
- 2
- 3
- 4
Otoplasty*
- 1
- 2
- 3
- 4
Rhinoplasty*
- 1
- 2
- 3
- 4
Reduction of Facial Fracture*
- 1
- 2
- 3
- 4
Scar Revisions*
- 1
- 2
- 3
- 4
Skin Grafting*
- 1
- 2
- 3
- 4
Eye
Excision of Chalazion*
- 1
- 2
- 3
- 4
Canthotomy*
- 1
- 2
- 3
- 4
Correction of Ectropian/ Entropian*
- 1
- 2
- 3
- 4
Corneal Transplant*
- 1
- 2
- 3
- 4
Enucleation*
- 1
- 2
- 3
- 4
I.O.I. Implants*
- 1
- 2
- 3
- 4
Lacrimal Duct Probing*
- 1
- 2
- 3
- 4
Refractive Keratoplasty*
- 1
- 2
- 3
- 4
Repair of Retinal Detachment*
- 1
- 2
- 3
- 4
Vitrectomy*
- 1
- 2
- 3
- 4
Ear, Nose & Throat
Caldwell-Luc*
- 1
- 2
- 3
- 4
Ethmoidectomy*
- 1
- 2
- 3
- 4
Frontal Flap Sinus Procedure*
- 1
- 2
- 3
- 4
Laryngectomy*
- 1
- 2
- 3
- 4
Radical Neck*
- 1
- 2
- 3
- 4
Septoplasty*
- 1
- 2
- 3
- 4
Sinusotomy*
- 1
- 2
- 3
- 4
Tonsillectomy & Adenoidectomy*
- 1
- 2
- 3
- 4
Tracheostomy*
- 1
- 2
- 3
- 4
Myringotomy*
- 1
- 2
- 3
- 4
Mastoidectomy*
- 1
- 2
- 3
- 4
Tympanoplasty*
- 1
- 2
- 3
- 4
Stapedectomy*
- 1
- 2
- 3
- 4
Nasal Polypectomy*
- 1
- 2
- 3
- 4
Laryngoscopy*
- 1
- 2
- 3
- 4
Endoscopy
Bronchoscopy*
- 1
- 2
- 3
- 4
Cardiothoracic
Chest Tube Set- Up*
- 1
- 2
- 3
- 4
Pneumonectomy/ Lobectomy*
- 1
- 2
- 3
- 4
Septal Defect Repair*
- 1
- 2
- 3
- 4
Sternal Splitting*
- 1
- 2
- 3
- 4
Thoracotomy*
- 1
- 2
- 3
- 4
Bronchoscopy*
- 1
- 2
- 3
- 4
Lung/ Wedge Resection*
- 1
- 2
- 3
- 4
Vein Harvesting*
- 1
- 2
- 3
- 4
A-V Shunts*
- 1
- 2
- 3
- 4
Aortic Aneurysm, Abdominal*
- 1
- 2
- 3
- 4
Aortofemoral Bypass*
- 1
- 2
- 3
- 4
Graft Insertion*
- 1
- 2
- 3
- 4
Cardiac Valve Replacement*
- 1
- 2
- 3
- 4
Coronary Artery Bypass Graft- on Pump*
- 1
- 2
- 3
- 4
Endarterectomy- Carotid/ Femoral*
- 1
- 2
- 3
- 4
Femoral- Popliteal Bypass*
- 1
- 2
- 3
- 4
External Temporary Pacemaker*
- 1
- 2
- 3
- 4
Internal Pacemaker Insertion*
- 1
- 2
- 3
- 4
Intra-Aortic Balloon Pump Catheter*
- 1
- 2
- 3
- 4
Patent Ductus Repair*
- 1
- 2
- 3
- 4
Pericardial Windows*
- 1
- 2
- 3
- 4
Portasystemic Shunt*
- 1
- 2
- 3
- 4
Repair of Septal Defects*
- 1
- 2
- 3
- 4
Thrombectomy*
- 1
- 2
- 3
- 4
Vena Cava Ligation*
- 1
- 2
- 3
- 4
Transplants
Bone Marrow*
- 1
- 2
- 3
- 4
Pancreas*
- 1
- 2
- 3
- 4
Heart*
- 1
- 2
- 3
- 4
Lung*
- 1
- 2
- 3
- 4
Liver*
- 1
- 2
- 3
- 4
Multhorgan*
- 1
- 2
- 3
- 4
Kidney*
- 1
- 2
- 3
- 4
Eye*
- 1
- 2
- 3
- 4
Trauma
Burns*
- 1
- 2
- 3
- 4
MVA*
- 1
- 2
- 3
- 4
Gun Shot Wounds*
- 1
- 2
- 3
- 4
Stab Wounds*
- 1
- 2
- 3
- 4
Equipment
Robotics*
- 1
- 2
- 3
- 4
List Type:
Fracture Tables*
- 1
- 2
- 3
- 4
List Type:
Video Systems*
- 1
- 2
- 3
- 4
List Type:
CUSA*
- 1
- 2
- 3
- 4
Cell Saver*
- 1
- 2
- 3
- 4
PACS Diagnostics*
- 1
- 2
- 3
- 4
Electrocautery*
- 1
- 2
- 3
- 4
List Type:
Drills*
- 1
- 2
- 3
- 4
List Type:
Saws*
- 1
- 2
- 3
- 4
List Type:
Stapling Devices*
- 1
- 2
- 3
- 4
List Type:
Cardiac Monitors*
- 1
- 2
- 3
- 4
List Type:
Position Patient Per Surgeon's Order*
- 1
- 2
- 3
- 4
Pressure Point Paddling*
- 1
- 2
- 3
- 4
Apply Tourniquet as Ordered*
- 1
- 2
- 3
- 4
Protect From Nerve damage*
- 1
- 2
- 3
- 4
Thermoregulation*
- 1
- 2
- 3
- 4
Use of fracture table*
- 1
- 2
- 3
- 4
Use of head stabilizer*
- 1
- 2
- 3
- 4
Use of body stabilizer*
- 1
- 2
- 3
- 4
Use of c-arm extensions*
- 1
- 2
- 3
- 4
Skin Assessment*
- 1
- 2
- 3
- 4
Use of retractors*
- 1
- 2
- 3
- 4
Packing with sponges*
- 1
- 2
- 3
- 4
Digital Manipulation of tissue*
- 1
- 2
- 3
- 4
Suctioning, Irrigation, Sponging*
- 1
- 2
- 3
- 4
Manipulation of Surgical Materials (Loops, tags)*
- 1
- 2
- 3
- 4
Clamping/Cauterizing vessels or tissues*
- 1
- 2
- 3
- 4
Tying/ligating clamped vessels or tissues*
- 1
- 2
- 3
- 4
Apply hemostatic clips*
- 1
- 2
- 3
- 4
Place Local Hemostatic Agents*
- 1
- 2
- 3
- 4
Direct Digital Pressure*
- 1
- 2
- 3
- 4
Assist in Volume Replacement*
- 1
- 2
- 3
- 4
Assist in Autotransfusion*
- 1
- 2
- 3
- 4
Suturing: all wound layers including muscle & fascia*
- 1
- 2
- 3
- 4
Wound dressing: liquid or spray occlusive*
- 1
- 2
- 3
- 4
Absorbent immobilizing dressing*
- 1
- 2
- 3
- 4
Assist to secure drainage system to tissue*
- 1
- 2
- 3
- 4
Insert/Remove Foley*
- 1
- 2
- 3
- 4
Drape Patient*
- 1
- 2
- 3
- 4
Electrocautery Mono*
- 1
- 2
- 3
- 4
Electrocautery Bipolar*
- 1
- 2
- 3
- 4
Cut Tissue*
- 1
- 2
- 3
- 4
Harvest saphenous vein, including skin incision*
- 1
- 2
- 3
- 4
Dissect Common Femoral Atery and Bifurcate*
- 1
- 2
- 3
- 4
Insert drainage tubes*
- 1
- 2
- 3
- 4
Application Agreement
*
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.*
*
I hereby consent to allow CrossMed Healthcare Staffing Solutions to release these skills checklist to the client facilities.*
Name*
First Last
Email*
Phone*
TODAY's DATE*
MM slash DD slash YYYY

Skills Checklist

Age of Patients Cared For

Miscellaneous

General Surgery

Laparoscopic Procedures

Gynecology

G.U. and CYSTO

Orthopedic

Neurosurgery

Plastics

Eye

Ear, Nose & Throat

Endoscopy

Cardiothoracic

Transplants

Trauma

Equipment

Application Agreement