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.
Newborn/Neonate (birth–30 days): 0★★★★−
Infant (1 month–1 year): 0★★★★−
Toddler (1–3 years): 0★★★★−
Preschooler (3–5 years): 0★★★★−
School Age Child (5–12 years): 0★★★★−
Adolescents (12–18 years): 0★★★★−
Young Adults (18–39 years): 0★★★★−
Middle Adults (39–64 years): 0★★★★−
Older Adults (64–79 years): 0★★★★−
Elderly Adults (over 79+ years): 0★★★★−
Standard Precautions: 0★★★★−
Isolation Precautions: 0★★★★−
Pediatric Respiratory/Cardiac Arrest: 0★★★★−
Adult Respiratory/Cardiac Arrest: 0★★★★−
Crash Carts: 0★★★★−
Defibrillators: 0★★★★−
Electronic Documentation: 0★★★★−
List Types (Electronic Documentation):
Automated Med Dispensing Systems: 0★★★★−
List Types (Med Dispensing):
10-20 Electrode Placement: [rating 10-20]
Portable Recording in Adult ICU: 0★★★★−
Portable Recording in Pediatric ICU: 0★★★★−
Portable Recording in NICU: 0★★★★−
ECI-Brain Death Recording: 0★★★★−
Ambulatory EEG: 0★★★★−
Sleep Deprived EEG: 0★★★★−
Sleep EEG: 0★★★★−
EMG: 0★★★★−
Somatosensory Evoked Potential (SSEP): 0★★★★−
Motor Evoked Potential: 0★★★★−
Visual Evoked Potential: 0★★★★−
Auditory Evoked Potential: 0★★★★−
Assist with Nerve Conduction Studies/EMG: 0★★★★−
Paper Machine Experience: 0★★★★−
Digital Machine Experience: 0★★★★−
Nicolet: 0★★★★−
Cadwell: 0★★★★−
Grass: 0★★★★−
Xltek: 0★★★★−
Nihon Kohden: 0★★★★−
Obtain Patient History: 0★★★★−
Changes in Patient Status: 0★★★★−
Stimulation: 0★★★★−
Hyperventilation: 0★★★★−
Post Hyperventilation: 0★★★★−
Interpreting EEG Pattern: 0★★★★−
Please list:
