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 (65+ years): 0★★★★−
Assessments, Family History, and Risk Factors: 0★★★★−
Start and Maintain Peripheral IV: 0★★★★−
Complete Pre-Procedure Checklist: 0★★★★−
Consent Forms/Permits: 0★★★★−
Discharge Instructions: 0★★★★−
Interpretation of Lab Values: 0★★★★−
Set-Up of Scope & Video Equipment: 0★★★★−
Cleaning of Scopes: 0★★★★−
Transport Pre-Procedure Patient to Lab: 0★★★★−
Provide Care for the Post-Procedure Patient: 0★★★★−
Transport Post-Procedure Patient to Unit: 0★★★★−
National Patient Safety Goals: 0★★★★−
Automated Med Dispensing System: 0★★★★−
List Types (Med Dispensing Systems):
Electronic Documentation: 0★★★★−
List Types (Electronic Documentation):
EGDs: 0★★★★−
Active GI Bleed: 0★★★★−
Bronchoscopy: 0★★★★−
Cautery Devices: 0★★★★−
Collection of Hot & Cold Biopsies: 0★★★★−
Colonoscopy: 0★★★★−
Endoscopic Ultrasound: 0★★★★−
ERCP: 0★★★★−
Esophageal Dilations: 0★★★★−
Manometry Studies: 0★★★★−
PEG Placement: 0★★★★−
Polypectomy: 0★★★★−
Sclerotherapy: 0★★★★−
Specimen Collection and Labeling: 0★★★★−
TEE: 0★★★★−
Variceal Banding: 0★★★★−
Assess Heart Sounds and Peripheral Pulses: 0★★★★−
EKG Interpretation and Monitoring: 0★★★★−
Non-invasive Cardiac Monitoring: 0★★★★−
Participate as a Team Member in Resuscitation: 0★★★★−
Perform Defibrillation: 0★★★★−
Recognize and Interpret Arrhythmias: 0★★★★−
ABG’s Interpretation of Values: 0★★★★−
Airway Management: 0★★★★−
Assess Lung Sounds: 0★★★★−
Assist with Intubation: 0★★★★−
Care of Patient with Mechanical Ventilation: 0★★★★−
Pulse Oximetry: 0★★★★−
Set Up Oxygen: 0★★★★−
Use of Ambu Bag: 0★★★★−
Identify Changes in Level of Consciousness: 0★★★★−
Assess Sensory, Motor, Speech: 0★★★★−
Assess Reflexes – Babinski, Gag: 0★★★★−
Calculate mcg/min and mcg/kg/min: 0★★★★−
Monitor Conscious Sedation: 0★★★★−
Use of Sedation Reversal Agents: 0★★★★−
Use of IV Infusion Pumps: 0★★★★−
Antibiotics: 0★★★★−
Benzodiazepines – Valium, Versed, Ativan: 0★★★★−
Insulin: 0★★★★−
Narcan: 0★★★★−
Narcotics – Morphine, Fentanyl: 0★★★★−
Neuromuscular Blocking Agents – Pavulon, Norcuron: 0★★★★−
Propofol – Diprivan: 0★★★★−
Romazicon – Flumazenil: 0★★★★−
Thrombolytics: 0★★★★−
