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Skills Checklists

Before you can begin applying for NurseChoice assignments, you need to complete a skills checklist. Required by hospitals, this mandatory form highlights your skills, proficiencies and experience in your specialty. The quickest and easiest way to complete your skills checklist is online. Just select your specialty from the list below, enter the necessary information on the form and click to submit. Once we receive your completed skills checklist you will be one step closer to finding a rewarding travel assignment that meets your needs.


Operating Room Surgical Technologist Skills Checklist

*
Denotes required field

This profile is for use by healthcare professionals in this discipline and specialty.  It will not be a determining factor for the program.
Please enter your full legal name as it appears on your Social Security Card.
First Name* Middle Name Last Name*
E-Mail Address* Phone Number*
 
 
Please mark your level of experience
1. No experience; requires education, training and supervision
2. Intermittent experience; may need support or supervision
3. Proficient; consistent experience, independent
4. Expert level; can teach/supervise others
 
WORK SETTING- ADULT POPULATION
1 2 3 4
 
CVOR
 
First Assist
 
General OR
 
Outpatient
 
Peds-General OR
 
Peds-CVOR
 
Trauma
 
Scrub Experience
 
GENERAL SURGERY
1 2 3 4
 
Abdominal Perineal Resection
 
Appendectomy/Cholescystectomy
 
Breast Biopsy
 
Colon Resection/Surgery
 
Fundoplication
 
Gastrectomy
 
Gastric Bypass/Roux-en-Y
 
Laparoscopic General Surgeries
 
Mastectomy
 
Splenectomy
 
Thyroidectomy
 
Scrub General Surgery
 
CARDIOVASCULAR
1 2 3 4
 
Aortic Bypass Surgery
 
Cardiac Bypass Surgery
 
Carotid Endarterectomy
 
Endoscopic Vascular Procedures
 
Endovascular Aneurysm Repair
 
Laparascopic Cardiac Surgery
 
Robotic Assisted Cardiac Surgery
 
Valve Replacement/Repair
 
Ventricular Assist Device
 
Scrub CV Surgery
 
THORACIC
1 2 3 4
 
Esophagogastrectomy
 
Lobectomy
 
Mediastinotomy/Sternotomy
 
Robotic Assisted Thoracic Surgery
 
Thoracoscopy/Nuss Procedure
 
Video Assisted Thoracoscopic Surgery
 
Scrub Thoracic Surgery
 
ORTHOPEDIC
1 2 3 4
 
Arthroscopy
 
Canulated Hip Screws
 
External Fixator
 
Foot Procedures
 
Hand Procedures
 
Intramedullary Rodding Procedure
 
Knee Ligament Repair
 
ORIF Hip Fractures
 
ORIF Other Fractures
 
Total Hip/Knee Replacement
 
Total Joint Replacement
 
Scrub Orthopedics
 
NEUROLOGICAL/SPINAL
1 2 3 4
 
Anterior Laminectomy/Spinal Fusion
 
Cerebral Aneurysm Clipping
 
Craniotomy
 
Insertion of Vagal Nerve Stimulator
 
Insertion of VP Shunt
 
Laparoscopic Anterior Laminectomy
 
Posterior Laminectomy/Spinal Fusion
 
Steriotactic Guided Brain Biopsy
 
Scrub Neurological/Spinal Surgery
 
GENITOURINARY
1 2 3 4
 
Cystoscopy/TURP
 
Laparoscopic Assisted GU Procedures
 
Nephrectomy
 
Orchidectomy/Orchidopexy
 
Prostatectomy
 
Stress Incontinence Procedures
 
Ureterostomy
 
Scrub Genitourinary Surgery
 
GYNECOLOGICAL
1 2 3 4
 
Abdominal Hysterectomy
 
Anterior Posterior Repair
 
Cervical Cryo Surgery
 
Laparoscopic Assisted Hysterectomy
 
Laparotomy with Microtuboplasty
 
Robotic Assisted GYN Procedures
 
Scrub GYN Surgery
 
EAR/NOSE/THROAT
1 2 3 4
 
Endoscopic ENT Procedures
 
Laryngectomy
 
Mastoidectomy
 
Radical Neck
 
Septoplasty
 
Tonsillectomy & Adenoidectomy
 
Tracheostomy
 
Scrub ENT Surgery
 
CRANIOFACIAL/ORAL
1 2 3 4
 
Leforte Procedures
 
ORIF Mandibular Fracture
 
Otoplasty
 
Other Craniofacial Reconstructions
 
Scrub Craniofacial/Oral
 
PLASTIC
1 2 3 4
 
Blephoroplasty
 
Breast Augmentation
 
Breast Reconstruction with Implant
 
Breast Reduction Mammoplasty
 
Face Lift
 
Mastectomy with Tram Flap Reconstruction
 
Rhinoplasty
 
Rhytidectomy (Face Lift)
 
Skin Graft
 
Scrub Plastics
 
TRANSPLANTS
1 2 3 4
 
Corneal
 
Heart
 
Liver
 
Lung
 
Organ Donation
 
Pancreas
 
Scrub Transplants
 
OPHTHAMOLOGY
1 2 3 4
 
Cataract Surgery
 
Enucleation
 
Retinal Detachement Procedures
 
Scrub Ophthalmology
 
IF NO PEDIATRIC EXPERIENCE SKIP TO EQUIPMENT SECTION
 
WORK SETTING -PEDIATRIC POPULATION
 
CVOR
 
First Assist
 
General OR
 
Outpatient
 
Peds-General OR
 
Peds-CVOR
 
Trauma
 
Scrub Experience
 
GENERAL SURGERY
1 2 3 4
 
Anal Fistulectomy/Anoplasty
 
Gastroschisis Repair
 
Kasai Procedure (Hepato-Portoenterostomy)
 
Shuster Procedure (Omphalocele Repair)
 
Tracheoesophageal Fistula Repair
 
Scrub Peds General Surgery
 
GENITOURINARY
1 2 3 4
 
Nephrectomy
 
Orchidectomy/Orchidopexy
 
Pyloplasty
 
Repair of Hypospadias
 
Ureteral Procedures
 
Scrub Peds GU
 
NEURO
1 2 3 4
 
Craniotomy
 
Insertion of VP Shunt
 
Rhizotomy
 
Spinal Fusion
 
Scrubs Peds Neuro
 
CARDIAC/VASCULAR
1 2 3 4
 
Arterial Switch
 
ASD/VSD Repair
 
Atrial Septectomy
 
Bidirectional Glenn
 
Blalock-Taussig Shunt
 
Fontan Procedure
 
Norwood Procedure
 
PDA Ligation
 
Repair of Coarctation of Aorta
 
Ross Procedure
 
Tetralogy of Fallot Repair
 
Scrub Peds Cardiac/Vascular
 
TRANSPLANT
1 2 3 4
 
Heart
 
Kidney
 
Liver/Pancreas
 
Lung
 
Organ Donation
 
Pancreas
 
Scrub Peds Transplant
 
OPHTHAMOLOGY
1 2 3 4
 
Corneal Transplant
 
Eye Muscle Surgery
 
Orbitotomy of Eye
 
Repair of Ptosis
 
Scrub Peds Opthalmology
 
EAR/NOSE/THROAT
1 2 3 4
 
Cochlear Implant
 
Laryngotracheoplasty
 
Myringotomy with Tubes
 
Septoplasty
 
Suspension Microlaryngoscopy
 
Tonsillectomy & Adenoidectomy
 
Tracheostomy
 
Tympanoplasty/Typanomastoidectomy
 
Scrub Peds ENT
 
CRANIOFACIAL/ORAL/PLASTICS
1 2 3 4
 
Craniofacial Reconstruction
 
Dental Surgery
 
Leforte Maxillary Procedure
 
Mandibular Osteotomy
 
Open Cranial Vault Remodeling
 
Repair of Cleft Lip, Nose, Palate
 
Rhinoplasty
 
Scrub Peds C-Fl/Oral/Plastics
 
ORTHOPEDICS
1 2 3 4
 
Acetabuloplasty/Triple Innominate
 
Arthroscopy of Knee, Wrist, Shoulder
 
Closed Reduction, Percutaneous Pin
 
External Fixators
 
Femoral Varus Derotational Osteotomy
 
ORIF Fractures
 
Tendoachilles Lengthening
 
Scrub Peds Ortho
 
OR EQUIPMENT
1 2 3 4
 
Lasers (List Types)
 
OR Fracture Tables (List Types)
 
Robotics Systems (List Types)
 
Spinal Fusion Instrumentation (List Types)
 
PROFESSIONAL KNOWLEDGE AND SKILLS
1 2 3 4
 
Malignant Hyperthermia Protocol
 
Universal Protocol
 
AGE SPECIFIC/POPULATION-BASED CARE
1 2 3 4
 
Neonate/Infant
 
Toddler/Preschool
 
School Age
 
Adolescents
 
Young/Middle Adults
 
Older Adults/Geriatrics
 
CERTIFICATIONS (Current at time of completing this form)
 
BLS
 
Certified Surgical Technologist (CST)
 
Certified Sterile Processing Technologist (CSPT)
 
CPR
 
Other: Specify
Operating Room Surgical Technologist Skills Checklist, version 6

I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. Falsification of any information provided, will result in being ineligible to travel with AMN. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.

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