Medical Laboratory Skills Checklist

Fill Out and Submit your Skills Checklist

(Medical Laboratory)

Your name

Your Email

Last 4 Of SSN

Date

E-Signature

I hereby certify that ALL information I have provided 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

Medical Laboratory

Blood bank:

★★★★

Chem:

★★★★

Hemo:

★★★★

Micro:

★★★★

Serol:

★★★★

Procedure

Patient positioning:

★★★★

Fingerstick:

★★★★

Venipuncture:

★★★★

Warming the puncture site:

★★★★

Tourniquet application & removal:

★★★★

Decontamination of the puncture site:

★★★★

Tuberculosis exposure control plan:

★★★★

Post venipuncture site care:

★★★★

Order of tube collection:

★★★★

Equipment

Arterial blood gas kits:

★★★★

Occult blood packets:

★★★★

Heel warmers:

★★★★

Pin worm kits:

★★★★

Serum separators:

★★★★

Blood culture preparation kits:

★★★★

Centrifuge:

★★★★

Capillary blood kits:

★★★★

Bacteria media:

★★★★

Drug screen kits:

★★★★

Ova parasite containers:

★★★★

Legal blood draw kits:

★★★★

Paternity blood draw kits:

★★★★

RSV kits:

★★★★

Chemistry

Acetone analysis:

★★★★

Atomic absorption:

★★★★

B12/folates:

★★★★

CSF protein:

★★★★

Drug monitoring:

★★★★

Electrolytes:

★★★★

Electrophoresis:

★★★★

Gas chromatography:

★★★★

Hepatitis:

★★★★

Hormone testing:

★★★★

Immunoelectrophoresis:

★★★★

Include blood gas:

★★★★

Main chemistry unit:

★★★★

Osmolality:

★★★★

Stool analysis (fecal fats):

★★★★

Thin layer chromatography:

★★★★

Thyroid testing:

★★★★

Tumor markers:

★★★★

RIA

Background counts:

★★★★

Counters:

★★★★

Curves/regressions:

★★★★

Data reduction:

★★★★

Instrumentation/gamma:

★★★★

Radiation safety techniques:

★★★★

Scintillation counter:

★★★★

Blood Bank

Antibody identification:

★★★★

Antibody titer:

★★★★

Blood irradiation:

★★★★

Component preparation:

★★★★

Coombs test

Direct:

★★★★

Indirect:

★★★★

Cross match:

★★★★

Donor unit collections:

★★★★

Emergency release:

★★★★

Freezing blood:

★★★★

Immediate spin cross match:

★★★★

Patient identification:

★★★★

Plasmapheresis:

★★★★

Plateletpheresis:

★★★★

Procedures:

★★★★

Rhogam:

★★★★

Antigen typing:

★★★★

Type RH:

★★★★

Microbiology/Virology

Concentration techniques:

★★★★

Identification:

★★★★

Acid fast stain (fluorescent):

★★★★

Acid fast stain (kinyoun):

★★★★

Anaerobic culture:

★★★★

Anaerobic identification:

★★★★

Blood culture:

★★★★

C. difficile assay:

★★★★

Cell culture technique (viral):

★★★★

Chlamydia culture:

★★★★

Chlamydia smear:

★★★★

Culture plating:

★★★★

Darkfield:

★★★★

Gram stain:

★★★★

India ink:

★★★★

KOH prep:

★★★★

Malarial examination:

★★★★

Mycobacteria culture:

★★★★

Occult blood:

★★★★

Organism identification:

★★★★

Ova & parasite concentration:

★★★★

Trichcone:

★★★★

Sensitives

K.B.:

★★★★

M.I.C.:

★★★★

Virus isolation:

★★★★

Wet mount-motility:

★★★★

Urinalysis

Automated instrumentation:

★★★★

Large volume automation equipment:

★★★★

Small volume automation equipment:

★★★★

Crystal identification:

★★★★

Macroscopic U.A:

★★★★

Microscopic U.A:

★★★★

Semen analysis:

★★★★

Hematology

Bleeding time:

★★★★

Body fluid count:

★★★★

CBC:

★★★★

D-dimer:

★★★★

Differential:

★★★★

Eosinophil count:

★★★★

Factor assays:

★★★★

Fetal hemoglobin:

★★★★

Fibrin split products/FDP:

★★★★

Fibrinogen:

★★★★

Lee-White clotting time:

★★★★

Platelet aggregation:

★★★★

Platelet count:

★★★★

PT & PTT:

★★★★

Reticulocyte count:

★★★★

Sedimentation rate:

★★★★

Special stains (PAS, peroxidase, leukocyte alkaline phosphatase):

★★★★

Sickle cell prep:

★★★★

Thrombin time:

★★★★

Serology / Immunology

ANA:

★★★★

ASO titer:

★★★★

C3, C4, total complement:

★★★★

Cold agglutinins:

★★★★

C-reactive protein:

★★★★

ELISA testing:

★★★★

Febrile agglutinations:

★★★★

Fluorescent testing:

★★★★

FTA-ABS:

★★★★

Hemagglutination inhibition:

★★★★

LE cell prep:

★★★★

Monospot:

★★★★

Pregnancy testing:

★★★★

Radial immuno diffusion:

★★★★

Rheumatoid factor:

★★★★

RPR:

★★★★

Rubella serology:

★★★★

TORCH studies:

★★★★

National Patient Safety Goals

Accurate patient identification:

★★★★

Labeling:

★★★★

Effective communication:

★★★★

Infection control:

★★★★

Quality control/quality assurance:

★★★★

Assist with On-site procedure:

★★★★

Age Specific Competencies

Newborn/neonate (birth-30 days):

★★★★

Infant (31 days-1 year):

★★★★

Toddler (ages 2-3 years):

★★★★

Preschool (ages 4-5 years):

★★★★

School age (ages 6-12 years):

★★★★

Adolescent (ages 13-21 years):

★★★★

Young adult (ages 22-39 years):

★★★★

Adult (ages 40-64 years):

★★★★

Older adult (ages 65-79 years):

★★★★

Elderly (ages 80+ years):

★★★★

Please list any Additional Skills

Additional Skill 1:

Additional Skill 2:

Additional Skill 3:

Additional Skill 4:

Additional training

Training 1:

Training 2:

Training 3:

Training 4:

Additional training

Training 1:

Training 2:

Training 3:

Training 4: