Skill Checklists
Certified Surgical First Assistant
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
Adult Respiratory/ Cardiac Arrest
Autoclave
Automated Med Dispensing Systems
Care of Scopes and Fiberoptic Equipment
Cidex Soap
Crash Cart
Defibrillator
Electronic Documentation
Hand-off Communication
Isolation Precautions
Patient Identification
Pediatric Respiratory/ Cardiac Arrest
Standard Precautions
Universal Protocol
Newborn/Neonate (birth to 30 days)
Infant (1 month to 1 year)
Toddler (1 year to 3 years)
Preschooler (3 years to 5 years)
School Age Child (5 years to 12 years)
Adolescents (12 years to 18 years)
Young Adults (18 years to 39 years)
Middle Adults (39 years to 64 years)
Older Adults (64 years to 79 years)
Elderly Adults (over 79+ years)
Abdominal Perineal Resection
Adrenalectomy
Bowel Resection
Cholecystectomy
Colostomy/Ileostomy
Gastrectomy
Hemicolectomy
Hepatic Resection
Herniorrhaphy-Femoral/ Inguinal
Hiatal Herniorrhaphy- Transabdominal
Pancreatectomy
Organ Procurement
Radical Mastectomy
Saphenous Vein Ligation and Stripping
Splenectomy
Thyroidectomy
Tracheostomy
Whipple Procedure
Hysterectomy
Appendectomy
Hernia Repair
Colon Resection
Caesarean Section
Dilation and Curettage
Hysterectomy-Vaginal
Hysterectomy-Abdominal
Laser Surgery
Radium Insertion
Salpingo- Oopherectomy
Shirodkar Procedure
Termination of Pregnancy
Tubal Ligation
Vaginectomy
Vaginal Reconstruction
Circumcision
Cystoscopy/ Cystostomy
Cystectomy
Hypospadius Repair
Ileal Loop
Lithotripsy
Nephrectomy
Orchiectomy
Penile Implant
Prostatectomy
Ureterolithotomy
Ureteroscopy
T.U.R.P./T.U.R.B
Vasectomy
Amputation- Leg/ Arm
Application of Halo Traction
Arthroscopy/ Arthrotomy
Closed Pinning and Reduction of Extremities
External Compression Devices
Insertion of Finger Prosthesis
Total Joint Replacement- Knee, Hip, Shoulder
Spinal Fusion-Harrington Rods
Spica Cast Application
O.R.I.F.-Shoulder, Hip, Humerus, etc.
Repair of Dislocation
Patellectomy
Tendon Implants and Reanastomosis
Anterior Cervical Fusion
AV Malformation
Burrholes for Subdural Hematoma
Craniotomy
Discectomy/ Laminectomy
Laminectomy
Meningocele Repair
Nerve Stimulators
Shunt Procedures- VP/ VA
Spinal Procedures/ Fusions
Abdominoplasty/Abdominal Lipectomy
Augmentation Mammoplasty
Breast Reduction/ Reconstruction
Cleft Lip/Palate Repair
Dermabrasion
Digital Flexor Tendon Repair
Face Lift
Liposuction
Otoplasty
Rhinoplasty
Reduction of Facial Fracture
Scar Revisions
Skin Grafting
Excision of Chalazion
Canthotomy
Correction of Ectropian/ Entropian
Corneal Transplant
Enucleation
I.O.I. Implants
Lacrimal Duct Probing
Refractive Keratoplasty
Repair of Retinal Detachment
Vitrectomy
Caldwell-Luc
Ethmoidectomy
Frontal Flap Sinus Procedure
Laryngectomy
Radical Neck
Septoplasty
Sinusotomy
Tonsillectomy and Adenoidectomy
Myringotomy
Mastoidectomy
Tympanoplasty
Stapedectomy
Nasal Polypectomy
Laryngoscopy
Bronchoscopy
Chest Tube Set- Up
Pneumonectomy/ Lobectomy
Septal Defect Repair
Sternal Splitting
Thoracotomy
Lung/ Wedge Resection
Vein Harvesting
A-V Shunts
Aortic Aneurysm, Abdominal
Aortofemoral Bypass
Graft Insertion
Cardiac Valve Replacement
Coronary Artery Bypass Graft- on Pump
Endarterectomy- Carotid/ Femoral
Femoral- Popliteal Bypass
External Temporary Pacemaker
Internal Pacemaker Insertion
Intra-Aortic Balloon Pump Catheter
Patent Ductus Repair
Pericardial Windows
Portasystemic Shunt
Repair of Septal Defects
Thrombectomy
Vena Cava Ligation
Bone Marrow
Pancreas
Heart
Lung
Liver
Multhorgan
Kidney
Eye
Burns
MVA
Gun Shot Wounds
Stab Wounds
Robotics
Fracture Tables
Video Systems
CUSA
Cell Saver
PACS Diagnostics
Electrocautery
Drills
Saws
Stapling Devices
Cardiac Monitors
Position Patient Per Surgeon's Order
Pressure Point Paddling
Apply Tourniquet as Ordered
Protect From Nerve damage
Thermoregulation
Use of fracture table
Use of head stabilizer
Use of body stabilizer
Use of c-arm extensions
Skin Assessment
Use of retractors
Packing with sponges
Digital Manipulation of tissue
Suctioning, Irrigation, Sponging
Manipulation of Surgical Materials (Loops, tags)
Clamping/Cauterizing vessels or tissues
Tying/ligating clamped vessels or tissues
Apply hemostatic clips
Place Local Hemostatic Agents
Direct Digital Pressure
Assist in Volume Replacement
Assist in Autotransfusion
Suturing: all wound layers including muscle & fascia
Wound dressing: Liquid or spray occlusive
Absorbent immobilizing dressing
Assist to secure drainage system to tissue
Insert/Remove Foley
Drape Patient
Electrocautery Mono
Electrocautery Bipolar
Cut Tissue
Harvest saphenous vein, including skin incision
Dissect Common Femoral Atery and Bifurcate
Insert drainage tubes
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.
