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.
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
CT TECHNOLOGIST SKILLS
Abdominal: 0★★★★−
Pancreas: 0★★★★−
Liver: 0★★★★−
Pelvis: 0★★★★−
Temporomandibular: 0★★★★−
Adrenal: 0★★★★−
Aorta: 0★★★★−
Thorax: 0★★★★−
Brain CT Scans Contrast Non-contrast: 0★★★★−
Chest: 0★★★★−
Orbit: 0★★★★−
Pulmonary embolism: 0★★★★−
Internal Auditory canal: 0★★★★−
Facial Bone: 0★★★★−
Sinus: 0★★★★−
Mastoid Scan: 0★★★★−
Neck Scans: 0★★★★−
Thoracic Scans: 0★★★★−
Cervical Spines: 0★★★★−
Lumbar/Sacral Spine Scans: 0★★★★−
Post Myelogram scans: 0★★★★−
Trauma Spinal scans: 0★★★★−
Upper extremity scans: 0★★★★−
Lower extremity scans: 0★★★★−
Renal CT Renal cyst puncture: 0★★★★−
Spin-echo images: 0★★★★−
Surface coils: 0★★★★−
Biopsy procedures: 0★★★★−
Gradient Echo imaging: 0★★★★−
CT guided Thoracic drainage's, abdominal drainages.: 0★★★★−
Pediatric Head CT Scans: 0★★★★−
Pediatric thoracic and abdominal CT Scans: 0★★★★−
Quality improvement studies/participation.: 0★★★★−
EQUIPMENT USAGE
General Electric: 0★★★★−
Hitachi: 0★★★★−
Kodak Processor: 0★★★★−
Siemens: 0★★★★−
Phillips: 0★★★★−
High speed Advantage: 0★★★★−
Radiation badge/ PPE: 0★★★★−
Hewlett Packard: 0★★★★−
Age Specific Competencies
Infant (Birth - 1 year): 0★★★★−
Preschooler (ages 2-5 years): 0★★★★−
Childhood (ages 6-12 years): 0★★★★−
Adolescents (ages 13-21 years): 0★★★★−
Young Adults (ages 22-39 years): 0★★★★−
Adults (ages 40-64 years): 0★★★★−
Older Adults (ages 65-79 years): 0★★★★−
Elderly (ages 80+ years): 0★★★★−
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