Skills Checklist - Sterile Processing Technologies - Origin Travel Nurses

Skills Checklist - Sterile Processing Technologist

Name
First Last
Phone
Email
PROCESSING*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Single Instruments
Endoscopes
Repair
Sets/ Trays
Care of Instruments

DECONTAMINATION*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Steam Sterilization
Low Temperature Sterilization
Manual cleaning
Washer Sterilizer
Soiled Linen
Disinfectants
Sharps
Disposable Items
Cleaning Equipment
Detergents
Dress code
Proper labeling.

OTHER (LIST):*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Test Control
Recording

ASSEMBLY AND PREPARATION*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Sterile Storage Standards
Wrapping materials
Autoclave tape
Dust covers
Proper towel/ linen folding
Proper labeling
Expiration dates
Packing for steam
Heat sealing
Instrument count sheets
Placing instruments on trays

Age Group Experience*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Newborn (birth - 30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschooler (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)

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