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Last 4 Of SSN
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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.
General OR 0★★★★−
CVOR 0★★★★−
Outpatient 0★★★★−
Trauma 0★★★★−
Peds-General OR 0★★★★−
Peds-CVOR 0★★★★−
First Assist 0★★★★−
Scrub Experience 0★★★★−
Abdominal Perineal Resection 0★★★★−
Appendectomy/Cholescystectomy 0★★★★−
Breast Biopsy 0★★★★−
Colon Resection/Surgery 0★★★★−
Gastrectomy 0★★★★−
Gastric Bypass/Roux-en-Y 0★★★★−
Hemorrhoidectomy 0★★★★−
Herniorrhaphy - Inguinal, Ventral, Femoral, Umbilical 0★★★★−
Laparoscopic General Surgeries 0★★★★−
Laparoscopic Nissen Fundoplication 0★★★★−
Mastectomy 0★★★★−
Splenectomy 0★★★★−
Thyroidectomy 0★★★★−
Scrub General Surgery 0★★★★−
Aorta Repair 0★★★★−
Aorto-Bifemoral/Femoral-Pop Bypass Graft 0★★★★−
Cardiac Bypass Surgery 0★★★★−
Carotid Endarterectomy 0★★★★−
Endoscopic Vascular Procedures 0★★★★−
Femoral Popliteal Bypass Graft 0★★★★−
Laparascopic Cardiac Surgery 0★★★★−
Robotic Assisted Cardiac Surgery 0★★★★−
Valve Replacement/Repair 0★★★★−
Ventricular Assist Device 0★★★★−
Scrub CV Surgery 0★★★★−
Endoscopic Thoracic Procedures 0★★★★−
Esophagoogastrectomy 0★★★★−
Mediastinotomy/Sternotomy 0★★★★−
Thoracoscopy/Nuss Procedure 0★★★★−
Thoracotomy 0★★★★−
Scrub Thoracic Surgery 0★★★★−
Total Joint Replacement 0★★★★−
Closed Reduction of Fracture 0★★★★−
External Fixator 0★★★★−
Cannulated Hip Screws 0★★★★−
Bankhart Procedure 0★★★★−
Birmingham Procedure 0★★★★−
Carpal Tunnel Release 0★★★★−
Arthroscopy 0★★★★−
Anterior Cruciate Ligament Reconstruction 0★★★★−
Open Reduction Internal Fixation 0★★★★−
Scrub Orthopedics 0★★★★−
Craniotomy 0★★★★−
Steriotactic Guided Brain Biopsy 0★★★★−
Laminectomy 0★★★★−
Laparoscopic Anterior Laminectomy 0★★★★−
Insertion of Vagal Nerve Stimulator 0★★★★−
Insertion of VP Shunt 0★★★★−
Spinal Fusion 0★★★★−
Anterior Cervical Discectomy with Fusion 0★★★★−
Posterior Cervical Laminectomy 0★★★★−
Scrub Neurological Surgery 0★★★★−
Vasicaurethropexy 0★★★★−
Marshall Marchetti 0★★★★−
Circumcision 0★★★★−
Cystoscopy/Cystogram/Pyelogram 0★★★★−
Prostatectomy 0★★★★−
Nephrectomy 0★★★★−
Orchidectomy/Orchidopexy 0★★★★−
Ureterostomy 0★★★★−
Laparoscopic Assisted GU Procedures 0★★★★−
Robotic Assisted GU Procedures 0★★★★−
Scrub GU Surgery 0★★★★−
Abdominal Hysterectomy 0★★★★−
Anterior Posterior Repair 0★★★★−
C-Section 0★★★★−
D & C 0★★★★−
Laparoscopic Assisted Hysterectomy 0★★★★−
Laparotomy with Microtuboplasty 0★★★★−
Robotic Assisted GYN Procedures 0★★★★−
Vaginal Delivery 0★★★★−
Vaginal Hysterectomy 0★★★★−
Scrub Gyn Surgery 0★★★★−
Endoscopic ENT Procedures 0★★★★−
Laryngectomy 0★★★★−
Mastoidectomy 0★★★★−
Myringotomy with Insertion of Tubes 0★★★★−
Radical Neck 0★★★★−
Septoplasty 0★★★★−
Tonsillectomy & Adenoidectomy 0★★★★−
Tracheostomy 0★★★★−
Tympanoplasty 0★★★★−
Scrub ENT Surgery 0★★★★−
Craniectomy 0★★★★−
Craniofacial Reconstruction 0★★★★−
Dental Surgery 0★★★★−
Leforte 1 Maxillary/Sagittal Osteotomy 0★★★★−
ORIF Mandibular Fracture 0★★★★−
Otoplasty 0★★★★−
Reconstruction of Ear 0★★★★−
Removal of Arch Bars 0★★★★−
Repair of Cleft Lip, Nose, Palate 0★★★★−
Rhinoplasty 0★★★★−
Scrub Craniofacial/Oral 0★★★★−
Blephoroplasty 0★★★★−
Breast Reconstruction with Implant 0★★★★−
Breast Reduction Mammoplasty 0★★★★−
Face Lift 0★★★★−
Mastectomy with Tram Flap Reconstruction 0★★★★−
Split Thickness Skin Graft 0★★★★−
Suction Lipectomy 0★★★★−
Scrub Plastics 0★★★★−
Heart 0★★★★−
Lung 0★★★★−
Liver 0★★★★−
Pancreas 0★★★★−
Eye 0★★★★−
Organ Donation 0★★★★−
Scrub Transplants 0★★★★−
Cataract Extraction with Implant 0★★★★−
Vitrectomy 0★★★★−
Scleral Buckle 0★★★★−
Cataract Aspiration; Anterior Vitrectomy 0★★★★−
Corneal Transplant 0★★★★−
Scrub Ophthalmology 0★★★★−
Anal Fistulectomy/Anoplasty 0★★★★−
Appendectomy/Cholecystectomy 0★★★★−
Biopsy (Mass, Muscle, Lymph Node) 0★★★★−
Bronchoscopy 0★★★★−
Colostomy 0★★★★−
Esophagogastroduodenoscopy w/ Biopsy 0★★★★−
Esophagoscopy 0★★★★−
Exploratory Laparotomy 0★★★★−
Flexible Sigmoidoscopy 0★★★★−
Fundoplication 0★★★★−
Gastrostomy 0★★★★−
Herniorrhaphy 0★★★★−
Insertion of Port-a-Cath, Hickman, Broviac 0★★★★−
Laparascopic General Surgery Procedures 0★★★★−
Liver Biopsy 0★★★★−
Percutaneous Endoscopic Gastrostomy 0★★★★−
Scrub Peds General Surgery 0★★★★−
Hydrocelectomy 0★★★★−
Repair of Hypospadias 0★★★★−
Retrograde Pyelogram 0★★★★−
Scrub Peds GU 0★★★★−
Cochlear Implant 0★★★★−
Laryngotracheoplasty 0★★★★−
Myringotomy with Tubes 0★★★★−
Suspension Microlaryngoscopy 0★★★★−
Turbinate Reduction 0★★★★−
Tympanoplasty/Typanomastoidectomy 0★★★★−
Scrub Peds ENT 0★★★★−
Mandibular Osteotomy 0★★★★−
Skin Graft 0★★★★−
Scrub Peds C-Fl/Oral/Plastics 0★★★★−
Acetabuloplasty/Triple Innominate 0★★★★−
Arthroscopy of Knee, Wrist, Shoulder 0★★★★−
Closed Reduction, Percutaneous Pin 0★★★★−
External Fixator (Ilizarov/Orthofix) 0★★★★−
ORIF Shoulder, Humerus, Tibia, Femur 0★★★★−
Osteotomy/VDRD/Calcaneal/Metatarsal 0★★★★−
Spinal Fusion/Spinal with Instrumentation 0★★★★−
Tendoachilles Lengthening 0★★★★−
Scrub Peds Ortho 0★★★★−
Electrocautery (ESU) 0★★★★−
Laparoscopy Systems 0★★★★−
Neuro 0★★★★−
OR Fracture Tables (List Types) 0★★★★−
Orthopedic Total Joint Systems 0★★★★−
Power Equipment 0★★★★−
Robotics Systems (List types) 0★★★★−
Spinal Fusion Instrumentation 0★★★★−
Malignant Hyperthermia Protocol 0★★★★−
Administer and Monitor Moderate Sedation 0★★★★−
Universal Protocol for Wrong Site Surgery 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★★★★−
Age Specific/Population-Based Care 0★★★★−
Isolation Precautions 0★★★★−
Infection Prevention 0★★★★−
Epic 0★★★★−
Cerner 0★★★★−
Eclipsys 0★★★★−
McKesson 0★★★★−
Meditech 0★★★★−
Other Computerized System 0★★★★−
Computerized Physician Order Entry 0★★★★−
EMR Conversion YesNo
BLS
NRP
PALS
Certified Nurse Operating Room (CNOR)
Registered Nurse First Assist (RNFA)
Other: Specify
