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.
Angina 0★★★★−
Post Acute MI 0★★★★−
Congestive Heart Failure 0★★★★−
Post Cardiac Cath 0★★★★−
Post Cardiac Surgery 0★★★★−
Aneurysm 0★★★★−
Carotid Endarterectomy 0★★★★−
Post Vascular Surgery 0★★★★−
Post Cardiac Transplant 0★★★★−
Pneumonia 0★★★★−
COPD 0★★★★−
Tuberculosis 0★★★★−
Pulmonary Embolism 0★★★★−
Tracheostomy Management 0★★★★−
CPAP/BiPAP 0★★★★−
Interpretation of Arterial Blood Gases 0★★★★−
Post Lung Transplant 0★★★★−
Stroke Scale Assessment 0★★★★−
Traumatic Brain Injury 0★★★★−
CVA 0★★★★−
Post Craniotomy 0★★★★−
Seizure Disorders 0★★★★−
Spinal Cord Injuries 0★★★★−
Mood Disorders 0★★★★−
Substance Withdrawal 0★★★★−
Circulation/Skin Checks 0★★★★−
Continuous Passive Motion Devices 0★★★★−
Ambulation Assistive Devices 0★★★★−
Prosthetics 0★★★★−
Cast Care 0★★★★−
Pin Care 0★★★★−
Traction 0★★★★−
Total Joint Replacement 0★★★★−
Amputation 0★★★★−
Bariatrics 0★★★★−
Feeding Tubes 0★★★★−
GI Bleeding 0★★★★−
Bowel Obstruction 0★★★★−
GI Surgery 0★★★★−
Liver Disease 0★★★★−
Pancreatitis 0★★★★−
Post Liver Transplant 0★★★★−
Post Pancreas Transplant 0★★★★−
Arteriovenous Fistula/Shunt 0★★★★−
3 Way Catheter & Bladder Irrigation 0★★★★−
Suprapubic Catheter 0★★★★−
Renal Failure 0★★★★−
Peritoneal Dialysis 0★★★★−
GU Surgery 0★★★★−
Nephrostomy Tubes 0★★★★−
Renal Transplant 0★★★★−
Management Pre/Post Hemodialysis 0★★★★−
Gyn Surgery 0★★★★−
Diabetes Type I 0★★★★−
Diabetes Type II 0★★★★−
Blood Glucose Monitoring 0★★★★−
IV Insulin Protocols 0★★★★−
Management of Hypoglycemia 0★★★★−
Indwelling Insulin Pumps 0★★★★−
Pituitary Disorders 0★★★★−
Chemotherapy Administration 0★★★★−
Radiation Therapy 0★★★★−
Medical Oncology 0★★★★−
Surgical Oncology 0★★★★−
Radiation Implants 0★★★★−
Bone Marrow Transplant 0★★★★−
Antiarrhythmics 0★★★★−
Anticoagulants (IV, oral, & injection) 0★★★★−
Anti-Depressants 0★★★★−
Anti-Hypertensives 0★★★★−
Anti-Psychotics 0★★★★−
Benzodiazepines 0★★★★−
Emergency Medications 0★★★★−
Epidural Analgesia 0★★★★−
Inhaled Medications 0★★★★−
Insulin 0★★★★−
Narcotics/Opioid Analgesics (IV, oral, & injection) 0★★★★−
Nitrates (Oral & Topical) 0★★★★−
Non-Opioid Analgesics (IV, Oral, & Injection) 0★★★★−
Oral Hypoglycemics 0★★★★−
Patient Controlled Analgesia 0★★★★−
Procedural Sedation Administration 0★★★★−
Reversal Agents 0★★★★−
Steroids (IV, Oral, Inhaled) 0★★★★−
Automated Medication Dispensing (i.e. Pyxis, Omnicell) 0★★★★−
Starting IVs 0★★★★−
Central Line Blood Draws 0★★★★−
Central Line/Implanted Line Care 0★★★★−
TPN & Lipids 0★★★★−
Blood Product Administration 0★★★★−
Monitoring of Chemotherapy 0★★★★−
Placement of Telemetry Leads 0★★★★−
Rhythm Interpretation 0★★★★−
Dysrhythmia Management 0★★★★−
Obtain 12 Lead EKG 0★★★★−
Use of Rapid Response Teams 0★★★★−
National Patient Safety Goals/Core Measures 0★★★★−
Fall Risk Assessment/Prevention 0★★★★−
Pressure Ulcer Risk Assessment/Prevention 0★★★★−
Restraints/Use of Least Restrictive Device 0★★★★−
Patient/Family Teaching 0★★★★−
Age Specific/Population-Based Care 0★★★★−
Isolation Precautions 0★★★★−
Infection Prevention 0★★★★−
Pain Assessment & Management 0★★★★−
Charge Experience 0★★★★−
Interpretation and Communication of Lab Values 0★★★★−
Wound Care /Wound Vac 0★★★★−
Specialty Beds 0★★★★−
Epic 0★★★★−
Cerner 0★★★★−
Eclipsys 0★★★★−
McKesson 0★★★★−
Meditech 0★★★★−
Other Computerized System 0★★★★−
Computerized Physician Order Entry 0★★★★−
Bar Coding for Medication Administration 0★★★★−
EMR Conversion YESNO
BLS
ACLS
Telemetry Certificate
ONS Chemo/Biotherapy Certification
Other Chemo Certification
