Operating Room Surgical Technologist Skills Checklist The following checklist is a profile used to assess your Operating Room proficiency and assist in matching your skills with available assignments. Your employment is not dependent upon responses given on this checklist. Please rate your ability as accurately as possible by checking the appropriate option. Step 1 of 4 25% Name* First Middle Last PLEASE MARK YOUR LEVEL OF EXPERIENCE 0 - No Experience 1 - Theory/Observed Only 2 - Intermittent Experience 3 - Moderate Experience 4 – Expert ExperiencePlease indicate your years of experience in the following settings. General ORCVOROutpatientTraumaPediatrics - General ORPediatrics - CVORFirst AssistGeneral SurgeryAbdominal Perineal Resection01234Appendectomy/Cholescystectomy01234Breast Biopsy01234Colon Resection/Surgery01234Gastrectomy01234Gastric Bypass/Roux-en-Y01234Hemorrhoidectomy01234Herniorrhaphy - Inguinal, Ventral, Femoral, Umbilical01234Laparoscopic General Surgeries01234Laparoscopic Nissen Fundoplication01234Mastectomy01234Splenectomy01234Thyroidectomy01234CardiovascularAorta Repair01234Aorto-Bifemoral/Femoral-Pop Bypass Graft01234Cardiac Bypass Surgery01234Carotid Endarterectomy01234Endoscopic Vascular Procedures01234Femoral Popliteal Bypass Graft01234Laparascopic Cardiac Surgery01234Robotic Assisted Cardiac Surgery01234Valve Replacement/Repair01234Ventricular Assist Device01234ThoracicEndoscopic Thoracic Procedures01234Esophagogastrectomy01234Mediastinotomy/Sternotomy01234Thoracoscopy/Nuss Procedure01234Thoracotomy01234 OrthopedicTotal Joint Replacement01234Closed Reduction of Fracture01234External Fixator01234Cannulated Hip Screws01234Bankhart Procedure01234Birmingham Procedure01234Carpal Tunnel Release01234Arthroscopy01234Open Reduction Internal Fixation01234GynecologyHysterectomy-Abdominal01234Anterior Posterior Repair01234Caesarean Section01234Dilation & Curettage01234Laparoscopic Assisted Hysterectomy01234Laparotomy with Microtuboplasty01234Robotic Assisted GYN Procedures01234Vaginal Delivery01234Vaginal Hysterectomy01234NeurologicalCraniotomy01234Steriotactic Guided Brain Biopsy01234Laminectomy01234Laparoscopic Anterior Laminectomy01234Insertion of Vagal Nerve Stimulator01234Insertion of VP Shunt01234Spinal Fusion01234Anterior Cervical Discectomy with Fusion01234Posterior Cervical Laminectomy01234GenitourinaryVasicaurethropexy01234Marshall Marchetti01234Circumcision01234Cystoscopy/Cystogram/Pyelogram01234Prostatectomy01234Nephrectomy01234Orchidectomy/Orchidopexy01234Ureterostomy01234Laparoscopic Assisted GU Procedures01234Robotic Assisted GU Procedures01234OtolaryngologyEndoscopic ENT Procedures01234Laryngectomy01234Mastoidectomy01234Myringotomy with Insertion of Tubes01234Radical Neck01234Septoplasty01234Tonsillectomy & Adenoidectomy01234Tracheostomy01234Tympanoplasty01234 PlasticsCraniectomy01234Craniofacial Reconstruction01234Dental Surgery01234Leforte 1 Maxillary/Sagittal Osteotomy01234ORIF Mandibular Fracture01234Otoplasty01234Reconstruction of Ear01234Removal of Arch Bars01234Repair of Cleft Lip, Nose, Palate01234Rhinoplasty01234Blephoroplasty01234Breast Reconstruction with Implant01234Breast Reduction Mammoplasty01234Face Lift01234Mastectomy with Tram Flap Reconstruction01234Split Thickness Skin Graft01234Suction Lipectomy01234TransplantsHeart01234Lung01234Liver01234Pancreas01234Eye01234Organ Donation01234OpthamologyCataract Extraction with Implant01234Vitrectomy01234Scleral Buckle01234Cataract Aspiration; Anterior Vitrectomy01234Corneal Transplant01234 EquipmentElectrocautery (ESU)01234Laparoscopy Systems01234Neuro01234Orthopedic Total Joint Systems01234Power Equipment01234Spinal Fusion Instrumentation01234OR Fracture Tables (List types below)Robotics Systems (List types below)Professional Knowledge and SkillsMalignant Hyperthermia Protocol01234Infection Prevention01234Isolation Precautions01234National Patient Safety Goals/Core Measures01234Universal Protocol01234Additional SkillsSkillsEMR (please list out systems)TrainingEquipmentCertificationsClick on the + to add moreCertificationExpiration Date AcceptanceThe information I have given is true and accurate to the best of my knowledge. In addition, I hereby authorize Medestar to release this Operating Room Profile to client institutions of Medestar in consideration of my employment with that institution.SignatureUse your finger (if on a mobile device) or cursor to draw your signature.
