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.
Cardiac Anomalies 0★★★★−
CHF/Pulmonary Edema 0★★★★−
Cardiogenic Shock 0★★★★−
Cardioversion 0★★★★−
Heart Sounds 0★★★★−
Reactive Airway Disease 0★★★★−
Croup 0★★★★−
Pneumonia 0★★★★−
Epiglottitis 0★★★★−
Aspiration 0★★★★−
Airway Obstruction 0★★★★−
Hemo/Pneumothorax 0★★★★−
Chest Tube Placement/Management 0★★★★−
ABG Interpretation 0★★★★−
Meningitis/Encephalitis 0★★★★−
Seizures-Febrile/Epileptic 0★★★★−
Lumbar Puncture 0★★★★−
Migraine 0★★★★−
Fractures/Casting 0★★★★−
Open/Complex Fractures 0★★★★−
Nursemaid's Elbow 0★★★★−
Apply/Manage Splints 0★★★★−
Circulation Checks 0★★★★−
Crutch Walking 0★★★★−
Car Seat Instruction for Casted Patient 0★★★★−
Abdominal Trauma/Peritoneal Lavage 0★★★★−
Abdominal Pain 0★★★★−
Constipation 0★★★★−
GI Bleeding 0★★★★−
Hepatitis/Liver Failure 0★★★★−
Poison Ingestion 0★★★★−
Hypoglycemia 0★★★★−
Hyperglycemia 0★★★★−
DKA 0★★★★−
Acute Renal Failure 0★★★★−
UTI/Pyelonephritis 0★★★★−
Renal Trauma 0★★★★−
Testicular Torsion 0★★★★−
Menstrual Pain 0★★★★−
Ovarian Cyst 0★★★★−
Ectopic Pregnancy 0★★★★−
Pelvic Inflammatory Disease/STD 0★★★★−
Sexual Assault 0★★★★−
Reporting Acts of Violence 0★★★★−
Foreign Body - Eye 0★★★★−
Foreign Body - Ear 0★★★★−
Foreign Body - Nose 0★★★★−
Epistaxis 0★★★★−
Glasgow Coma/Pediatric Trauma Scale 0★★★★−
Trauma Code 0★★★★−
Trauma Team Member 0★★★★−
Brain Injury 0★★★★−
Spinal Cord Injury 0★★★★−
Spinal Precautions 0★★★★−
Facial/Dental Trauma 0★★★★−
Penetrating Trauma 0★★★★−
Blunt Trauma 0★★★★−
Traumatic Amputation 0★★★★−
Hypovolemic Shock 0★★★★−
Neurogenic Shock 0★★★★−
Anaphylactic Shock 0★★★★−
Septic Shock 0★★★★−
Burns - 2nd Degree 0★★★★−
Burns - 3rd Degree 0★★★★−
Contagious/Infectious Patients 0★★★★−
Isolation 0★★★★−
Reporting Communicable Disease 0★★★★−
Neutropenia/Reverse Isolation 0★★★★−
Drug /ETOH Overdose/Withdrawal 0★★★★−
Psychiatric Hold 0★★★★−
Suicidal Patient 0★★★★−
Pediatric Dosage Calculations 0★★★★−
Anti-Arrhythmics 0★★★★−
Anticoagulants (IV, Oral & Injection) 0★★★★−
Anti-Hypertensives 0★★★★−
Anti-Psychotics 0★★★★−
Anti-Seizure Medications 0★★★★−
Benzodiazepines 0★★★★−
Continuous IV Paralytics 0★★★★−
Continuous IV Sedation 0★★★★−
Procedural Sedation - Administration 0★★★★−
Ketamine 0★★★★−
Emergency Medications 0★★★★−
Inhaled Medications 0★★★★−
Insulin 0★★★★−
IV Vasopressors 0★★★★−
Narcotics/Opioid Analgesics (IV, Oral & Injection) 0★★★★−
Reversal Agents 0★★★★−
Steroids (IV, Oral & Inhaled) 0★★★★−
Automated Medication Dispensing (i.e. Pyxis, Omnicell) 0★★★★−
Recognizing/Reporting Abuse 0★★★★−
Triage 0★★★★−
Ambulance/Paramedic Radio 0★★★★−
Charge Experience 0★★★★−
EMTALA 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★★★★−
Car Seat Specific Standards/Teaching 0★★★★−
Age/Developmentally Specific/Population-Based Care 0★★★★−
Pain Assessment and Management - Verbal/Non-Verbal 0★★★★−
Interpretation and Communication of Lab Values 0★★★★−
Epic 0★★★★−
Cerner 0★★★★−
Eclipsys 0★★★★−
McKesson 0★★★★−
Meditech 0★★★★−
Allscripts 0★★★★−
Other Computerized System 0★★★★−
Computerized Physician Order Entry 0★★★★−
Bar Coding for Medication Administration 0★★★★−
EMR Conversion YESNO
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★★★★−
BLS
PALS
ACLS
PEARS
TNCC
ENPC
CEN
Other: Specify