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Anesthesia Technician

This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Fusion Medical Staffing.

  • 0 = Not Applicable
  • 1 = No Experience
  • 2 = Some Experience
  • 3 = Intermittent Experience
  • 4 = Experienced
  • 5 = Very Experienced
*Required
n/a
1
2
3
4
5

* Required

Age of Patients Cared For

Newborn/Neonate (birth to 30 days)*

Infant (1 month to 1 year)*

Toddler (1 year to 3 years)*

Preschooler (3 years to 5 years)*

School Age Child (5 years to 12 years)*

Adolescents (12 years to 18 years)*

Young Adults (18 years to 39 years)*

Middle Adults (39 years to 64 years)*

Older Adults (64 years to 79 years)*

Elderly Adults (over 79+ years)*

General Skills

Standard Precautions*

Isolation Precautions*

Pediatric Respiratory/Cardiac Arrest*

Adult Respiratory/Cardiac Arrest*

Crash Carts*

Electronic Documentation*

IV Pumps*

Sterile and Aseptic Technique*

Obtaining Vital Signs*

Transfer of Patient*

Patient Prep*

Procedure Set-Up*

Airway Maintenance*

Level of Consciousness*

Patient Positioning*

Placement of EKG Pads*

Placement of Oximetry Probe*

BIS Monitor*

Understands the Effects of Anesthesia Drugs*

Proper Identification of Patient using 2 Identifiers*

Proper Identification/Labeling of Lab/Specimen Results*

Pre-Procedural Time-Out Process*

Demonstrate Application of all Monitoring Devices*

Understand Scope of Practice and Limitations*

Prioritize Tasks Related to Role and Function*

Delegate Responsibilities to Other Anesthesia Team Members*

Knowledge of “Do Not Use” Abbreviations*

Fire, Electrical, Laser, and Explosion Hazards in the Operating Room/Anesthesia Related Areas*

Storage, Use, and Safe Handling of Bulk/Cylinder Gases*

Use of Common Anesthetic Gases*

Cleans, Sterilizes, Disinfects, Stocks, Orders, and Maintains Anesthesia Equipment/Supplies*

Implement Safety Procedures and Guidelines for Fire Safety and Infection Control*

Oxygen Administration

Ambu-Bag*

Nasal Cannula*

Non-Rebreather Mask*

Portable Oxygen*

Trach Collar*

Simple Masks*

Tracheostomy*

Venturi Masks*

Ventilator*

Assist With

Epidural Anesthesia/Analgesia*

Spinal Anesthesia*

General Anesthesia*

Regional Anesthesia*

Supplies

Types of ET*

LMA*

Oral/Nasal Airway*

Stylets*

Exchange Catheters*

Procedures/Equipment

Apply Cricoid Pressure*

Assist with Intubation*

Assist with Fiberoptic Intubations*

Provide Jaw Thrust*

Remove Stylet Suring Intubation*

Inflate ET Cuff*

Manually Ventilate While Placement Verified*

Secure Airway*

Invasive Line Placement

Prepare Sterile Field and Equipment*

Prepare Arterial Line Set-Up*

Prepare Central Venous Line Set-Up*

Prepare Peripheral Vascular Lines*

Assist with IA/IV Therapy*

Specimen Collections

Arterial Line Blood Draw*

Central Line Blood Draw*

Venipuncture*

Anesthesia Machine

Test Scavenging System Function*

Calibrate Oxygen Monitor*

Check Low Oxygen Alarm*

Verify Carbon Dioxide Absorbent is Adequate*

Breathing System Pressure and Leak Testing*

Verify Gas Flows Properly*

Document Checkout Procedures*

Ensure Proper Functioning Of

Suction*

IV Pump*

Hotline Fluid Warmer*

BIS Monitor*

Verify No Gas Leaks*

Flowmeters*

Rapid Infuser*

Ultrasound*

IABP*

TEE*

Bair Hugger*

Capnography*

Doppler*

Fiber-Optic/Flexible Scope*

Point of Care Testing Equipment

GEM*

ISTAT*

Glucometer*

TEG*

IV Pumps

Alaris*

Alibaba*

Bard*

Baxter*

Braun*

CADD*

IVAC*

Zynomed*

Other

Setting

Hospital OR*

Outpatient Clinic*

Physician Office*

Surgical Hospital*

Surgery Clinic*

Other Skills
Application Agreement

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Fusion Medical Staffing. Submit this skills evaluation with your initial application. To be updated annually.

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