Pediatric OR Skills Checklist

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

ENT/Plastics

Tonsillectomy/Adenoidectomy*

1
2
3
4

Tympanostomy/Tube Insertion*

1
2
3
4

Tympanoplasty/Tympanomastoidectomy/Micro-Ear Surgery*

1
2
3
4

Cochlear/Baha Implant*

1
2
3
4

Otoplasty/Microtia Repair*

1
2
3
4

Microlaryngoscopy/Bronchoscopy*

1
2
3
4

Laryngoscopy with Suspension/Intervention*

1
2
3
4

Tracheostomy*

1
2
3
4

Thyroidectomy*

1
2
3
4

Radical Neck Dissection*

1
2
3
4

Cleft Lip Repair*

1
2
3
4

Cleft Palate Repair/Alveolar Bone Graft*

1
2
3
4

Rhinoplasty*

1
2
3
4

Septoplasty*

1
2
3
4

Sinusectomy*

1
2
3
4

Mandibular Distraction*

1
2
3
4

Reduction of Facial Fractures*

1
2
3
4

Lasers*

1
2
3
4

Skin Grafting*

1
2
3
4

Orthopedics

Closed Reduction Internal Fixation (humerus, femur, etc.)*

1
2
3
4

Open Reduction Internal Fixation (humerus, femur, etc.)*

1
2
3
4

External Fixation Application*

1
2
3
4

Epiphysiodesis*

1
2
3
4

Arthoscopy (hip, knee, shoulder, etc.)*

1
2
3
4

Periacetabular Osteotomy (PAO)*

1
2
3
4

Total Joint Replacement*

1
2
3
4

Slipped Capital Femoral Epiphysis (SCFE)*

1
2
3
4

Ortho Trauma*

1
2
3
4

Bone Biopsy*

1
2
3
4

Tumor Resection/Limb/Joint Reconstruction*

1
2
3
4

Amputation*

1
2
3
4

Application of HALO Traction*

1
2
3
4

Spinal Fusion*

1
2
3
4

Eyes

Excision of Chalazion*

1
2
3
4

Canthotomy*

1
2
3
4

Strabismus*

1
2
3
4

Correction of Ectropion/Entropion*

1
2
3
4

Corneal Transplant*

1
2
3
4

Enucleation*

1
2
3
4

IOL Implants*

1
2
3
4

Lacrimal Duct Probing*

1
2
3
4

Repair of Retinal Detachment*

1
2
3
4

Vitrectomy*

1
2
3
4

Laser Treatment for Retinopathy of Prematurity*

1
2
3
4

General Surgery

Robotics*

1
2
3
4

Colorectal Abnormalities*

1
2
3
4

Umbilical Hernia Repair*

1
2
3
4

Inguinal Hernia Repair*

1
2
3
4

Hiatal Hernia Repair*

1
2
3
4

Nissen Fundoplication*

1
2
3
4

Pyloromyotomy*

1
2
3
4

Small bowel resection/ileostomy*

1
2
3
4

Colon Resection/colostomy*

1
2
3
4

ACE/Malone Procedure*

1
2
3
4

Gastrostomy*

1
2
3
4

Appendectomy (Laparoscopic or Open)*

1
2
3
4

Cholecystectomy (Laparoscopic or Open)*

1
2
3
4

Kasai Procedure*

1
2
3
4

Trauma*

1
2
3
4

Pectus Excavatum Repair*

1
2
3
4

Pectus Carinatum Repair*

1
2
3
4

Burns*

1
2
3
4

Wound Debridements*

1
2
3
4

ECMO*

1
2
3
4

Bariatrics*

1
2
3
4

Transplants

Heart*

1
2
3
4

Lung*

1
2
3
4

Liver*

1
2
3
4

Kidney*

1
2
3
4

Organ Procurement*

1
2
3
4

Other*

1
2
3
4

Urology/GYN

Circumcision*

1
2
3
4

Hypospadias Repair*

1
2
3
4

Orchiopexy*

1
2
3
4

Orchiectomy*

1
2
3
4

Testicular Implant*

1
2
3
4

Cystoscopy with/without intervention*

1
2
3
4

Ureteroscopy with/without intervention*

1
2
3
4

Laser Lithotripsy*

1
2
3
4

Mitrofanoff*

1
2
3
4

Cystectomy*

1
2
3
4

Pyeloplasty*

1
2
3
4

Nephrectomy/Radical Nephrectomy*

1
2
3
4

IUD Insertion*

1
2
3
4

Hysterectomy (Open or LAVH)*

1
2
3
4

Vaginal Reconstruction*

1
2
3
4

Hysteroscopy*

1
2
3
4

Neurosurgery

Anterior Cervical Fusion*

1
2
3
4

Laminectomy*

1
2
3
4

Spinal Fusion*

1
2
3
4

Release of Tethered Cord*

1
2
3
4

Chiari Decompression*

1
2
3
4

Burrholes for Subdural Hematoma*

1
2
3
4

Craniotomy*

1
2
3
4

Tumor Resection*

1
2
3
4

Meningocele Repair*

1
2
3
4

Shunt Procedures (VP/VA)*

1
2
3
4

Craniosynostosis/Cranial Remodeling*

1
2
3
4

Transphenoidal Hypophysectomy*

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.*

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*

Pediatric OR Skills Checklist

Pediatric OR

AGE OF PATIENTS CARED FOR

ENT/Plastics

Orthopedics

Eyes

General Surgery

Transplants

Urology/GYN

Neurosurgery

Traveler

Travel Jobs

Facilities

CrossMed

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