Skills Checklist – MTMLT

BLOOD BANK*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Patient Identification Process
ABO/Rh/Antibody Screen & ID
Crossmatch- Immediate Spin/ IgG
Antigen Typing
Antibody Typing: Gel Method
Antibody Typing: Tube Method
Cold Agglutinins
Rhogam Screening
Coombs Test Direct
Coombs Test Indirect
Cord Blood Evaluation
Thawing/ Cooling of Blood Products
Donor Collection Procedures
Issue Blood Product to Pt. Care Area
Emergency Release
Elutions
Transfusion Reaction Workshop
Irradiating Packed Cells
Splitting a Baby Unit

CHEMISTRY*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Specimen Preparation
Acetone Analysis
Arterial Blood Gas
B-12 Folates
Cardiac Enzymes
Chromatography- Gas
Chromatography- Thin Layer
Electropheresis
Hormone/ Thyroid
Immunoassay
Osmolality
Therapeutic Drug Monitoring
Tumor Markers
Analyzer Use/ Troubleshooting
Review & Interpretation of QC

HEMATOLOGY / COAGULATION*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Automated Instrument Use
Differential Manual
Sed Rate Manual
Reticulocyte Count
Fetal Hemoglobin
RBC Morphology
Platelet Count
Sickle Cell Prep
Platelet Morphology
Body Fluid Manual Cell Count
Body Fluid Manual diff.
Special Stains- e.g. PAS, LAP, Peroxidase
WBC Stool
Semen Analysis
PT/PTT/INR
D-Dimer
Fibrinogen
Factor Assays
Fibrin Degradation Products
Thrombin Time
Platelet Function Analysis

MICROBIOLOGY*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Plating Micro Specimens
Reading Plates
Gram Stains
Kit Testing- Monospot/ ASO Titer
Kit Testing- Flu/Rapid Strep/ RSV
Wet Prep/ KOH Prep
AFB Stain/ Culture
O&P
CDiff
Occult Blood
Chlamydia
Processing Specimens for Viral/ Fungal Cultures

PHLEBOTOMY*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Patient Identification
PPE Equipment (Gloves, Mask, Etc.)*
Adult Venipuncture*
Pediatric Venipuncture*
Dermal Stick (Finger/Heel)*
Butterfly Draw*
Arterial Draw*
Tube Types and Usage*
Centrifuge Operations*
Bleeding Time*
Blood Culture Collections*
Blood Alcohol Collections*
Drug Screening Collections*

Age Group Experience*

Do you speak any languages other than English?*
- No
If yes, enter languages above, separated by commas.
Confirmation*
- I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
Signature
Date
MM slash DD slash YYYY

Equipment List