Skill Checklists
Medical Physicist
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
Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler(1 - 3 years)
Preschool (3 - 5 years)
School Age (5 - 12 years)
Adolescents (12 - 18 years)
Young Adults (18 - 39 years)
Middle Adults (39 - 64 years)
Older Adults (64+ years)
Elderly Adults (Over 79+ years)
Standard Precautions
Isolation Precautions
Pediatric Respiratory/ Cardiac Arrest
Adult Respiratory/ Cardiac Arrest
Crash Carts
Defibrillators
The Clinical Environment
Simulation
Clinical Conduct
Chart Checking
Record and Verify Systems
Basic Radiation Safety
Linear Accelerator Quality Assurance
Acceptance Testing and Commissioning
Measurement Equipment QA
CT Simulator QA
Portal Imaging and kV X-Ray Imaging QA
Cone-Beam CT QA
PET-CT QA
HDR QA
Software Systems QA
Prevention of Technology-Related Errors
Prerequisites for Treatment Planning
Mark and Start Cases
3D-Conformal Planning
IMRT Planning
Protocols
Secondary Monitor Unit (MU) Checks
Block Cutting
Diodes/TLD
Beam Data Collection, Modeling, and Commissioning
Radiosurgery
LDR Brachytherapy
HDR Brachytherapy
TBI Electrons and Photons
IGRT Methods
Rotational Therapy
Proton Therapy
Radiation Safety
Instrumentation for Health Physics Measurements
Shielding Calculations
Isotope Procedures
American Board of Radiology
YesNo
American Board of Medical Physics
The Canadian College of Physicists in Medicine
The American College of Science in Nuclear Medicine
The American Board of Health Physics
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.
