Skill Checklists
Certified Surgical Tech
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
AKA/BKA (amputation)
Abdominal-Perineal Resection
Cholecystectomy (Open)
Exploratory Laparotomy
Appendectomy
Cholecystectomy
Hernia
Nissan
Colectomy
Gastrectomy
Inguinal / Ventral Hernia Repair
Spienectomy
Bowel Resection / Colostomy
Thyroidectomy
Rectal Procedures
Esophagascopy / Gastroscopy
Inguinal Hernia Repair
Pyloric Stenosis
Circumcision
Middle Ear Cases
T&A
Myringotomy
Tympanoplasty
Radical Neck Dissection
Septoplasty
Sinus Endoscopy
Coronary Artery By-pass
Mitral Valve Repair / Replacement
Aortic Valve Replacement
Multiple Valve Transposition
Septal Defects
Ventricular Aneurysm Repair
Bring Back Heart
Pericardial Window
Intra-Aortic Balloon Insertion
Heartport or Similar CABG
Thoraco Approach Mid-Cab
Aortic Arch Replacement
Aortic Valve Conduit
Mechanical Heart / LVAD
Pediatric Hearts
Tetrology of Fallot
Chamberlin Procedure
AICD Insertion
Saphenous Vein Harvest
Endoscopic Vein Harvest
Gastric Artery Harvest
Radial Vein Harvest
Insertion Vena Cava Filter
Thoracotomy
Thoracoscopy
Insertion Chest Tube
Esophageal Repair
Pneurnonectomy / Lobectomy
Mediastinodcopy
Desendind Aortic Repair
Arterial Stenting
Intra-Operative Angioplasty
Carotid Endarterectomy
Abdominal Aortic Aneurysm
Popliteal By-pass Graft (Insitu)
Popliteal By-pass Graft (Graph)
Portacath, Tesio, Hickman Placement
AV Shunt
Thrombectomy
Pacemaker Insertion
Subclavin / Carotid By-pass
Total Hip Replacement
Bipolar Hip
Compression Hip Screw
Total Knee Replacement
Knee Arthroscopy
ACL Knee Repair
Harrington Rod or Similar
I.M. Rodding
Hand Procedures
Foot Procedures
Screws & Plates
External Fixation
Shoulder Repair
Shoulder Arthroscopy
Spinal Fusion
Cast Application
Fracture Table Set-up
Drills, Saws and Reamers
Radical Prostatectomy
Radical Lymph Node Dissection
Ureteroscopy
TURP / TURST
Ultrasonic Lithotripsy
Hydrocelectomy
Cystoscopy
Insertion Penile Prosthesis
D & C
Diagnostic Laparascope
Laparoscopic Vaginal Hysterectomy
Abdominal Hysterectomy
Vaginal Hysterectomy
Anterior Repair
Posterior Repair
MMK (Marshall Marchetti Krantz)
Tuboplasty
BTL (Bilateral Tubal Ligation)
C-Sections
Cervical Laminectomy (Anterior)
Cervical Laminectomy (Posterior)
Lumbar Laminectomy Discectomy
Percutaneous Micro Discectomy
Craniotomy For Tumor
Craniotomy For Aneurysm
Burr Holes
VP Shunts
Transphenoidal Hypothypectomy
Carpal Tunnel Repair
Transplant Surgery
Organ Procurement (Harvest)
Mammoplasty
Facelifts
Skin Grafts
Rhinoplasty
Cleft Lip Repair
Abdominalplasty
Blepharoplasty
Otoplasty
Muscle Flaps
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
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.
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