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OR RN

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

Circulate - Experience With Ages

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)*

Circulate - General Surgery

General Surgery

Abdominal Perineal Resection (circulate)*

Adrenalectomy (circulate)*

Bariatrics (circulate)*

Bowel Resection (circulate)*

Cholecystectomy (circulate)*

Colostomy (circulate)*

Ileostomy (circulate)*

Gastrectomy (circulate)*

Hemicolectomy (circulate)*

Hepatic Resection (circulate)*

Herniorrhaphy-Femoral/ Inguinal (circulate)*

Hiatal Herniorrhaphy- Transabdominal (circulate)*

Pancreatectomy (circulate)*

Organ Procurement (circulate)*

Radical Mastectomy (circulate)*

Saphenous Vein Ligation and Stripping (circulate)*

Splenectomy (circulate)*

Thyroidectomy (circulate)*

Tracheostomy (circulate)*

Whipple Procedure (circulate)*

Circulate - Laparoscopic Procedures

Hysterectomy (circulate)*

Cholecystectomy (circulate)*

Appendectomy (circulate)*

Hernia Repair (circulate)*

Colon Resection (circulate)*

Circulate - Gynecology

Caesarean Section (circulate)*

Dilation & Curettage (circulate)*

Hysterectomy- Vaginal (circulate)*

Hysterectomy- Abdominal (circulate)*

Laser Surgery (circulate)*

Radium Insertion (circulate)*

Salpingo- Oopherectomy (circulate)*

Shirodkar Procedure (circulate)*

Termination of Pregnancy (circulate)*

Tubal Ligation (circulate)*

Vaginectomy (circulate)*

Vaginal Reconstruction (circulate)*

Circulate - G.U. and CYSTO

Circumcision (circulate)*

Cystoscopy/ Cystostomy (circulate)*

Cystectomy (circulate)*

Hypospadius Repair (circulate)*

Ileal Loop (circulate)*

Lithotripsy (circulate)*

Nephrectomy (circulate)*

Orchiectomy (circulate)*

Penile Implant (circulate)*

Prostatectomy (circulate)*

Ureterolithotomy (circulate)*

T.U.R.P./T.U.R.B (circulate)*

Vasectomy (circulate)*

Circulate - Orthopedic

Amputation- Leg/ Arm (circulate)*

Application of Halo Traction (circulate)*

Arthroscopy/ Arthrotomy (circulate)*

Closed Pinning & Reduction of Extremities (circulate)*

External Compression Devices (circulate)*

Insertion of Finger Prosthesis (circulate)*

Tooth Extractions (circulate)*

Total Hip Replacement (circulate)*

Total Shoulder Replacement (circulate)*

Total Knee Replacement (circulate)*

Spinal Fusion- Harrington Rods (circulate)*

Spica Cast Application (circulate)*

O.R.I.F.- Shoulder, Hip, Humerus, etc. (circulate)*

Repair of Dislocation (circulate)*

Patellectomy (circulate)*

Tendon Implants & Reanastomosis (circulate)*

Circulate - Neurosurgery

Anterior Cervical Fusion (circulate)*

Burrholes for Subdural Hematoma (circulate)*

Craniotomy (circulate)*

Laminectomy (circulate)*

Meningocele Repair (circulate)*

Shunt Procedures- VP/ VA (circulate)*

Circulate - Plastics

Skin Grafting (circulate)*

Face Lift (circulate)*

Abdominoplasty/ Abdominal Lipectomy (circulate)*

Augmentation Mammoplasty (circulate)*

Cleft Lip/ Palate Repair (circulate)*

Dermabrasion (circulate)*

Digital Flexor Tendon Repair (circulate)*

Liposuction (circulate)*

Myelomeningocele Repair (circulate)*

Otoplasty (circulate)*

Rhinoplasty (circulate)*

Reduction of Facial Fracture (circulate)*

Circulate - Eye

Cataracts (circulate)*

Excision of Chalazion (circulate)*

Canthotomy (circulate)*

Correction of Ectropian/ Entropian (circulate)*

Corneal Transplant (circulate)*

Enucleation (circulate)*

I.O.I. Implants (circulate)*

Lacrimal Duct Probing (circulate)*

Refractive Keratoplasty (circulate)*

Repair of Retinal Detachment (circulate)*

Vitrectomy (circulate)*

Circulate - Ear, Nose, and Throat

Caldwell-Luc (circulate)*

Ethymoidectomy (circulate)*

Frontal Flap Sinus Procedure (circulate)*

Laryngectomy (circulate)*

Open Reduction Facial Fractures (circulate)*

Radical Neck (circulate)*

Tonsillectomy & Adenoidectomy (circulate)*

Myringotomy (circulate)*

Mastoidectomy (circulate)*

Tympanoplasty (circulate)*

Stapedectomy (circulate)*

Nasal Polypectomy (circulate)*

Laryngoscopy (circulate)*

Circulate - Thoracic

Chest Tube Set- Up (circulate)*

Hiatal Hernia (circulate)*

Pneumonectomy/ Lobectomy (circulate)*

Sternal Splitting (circulate)*

Thoracotomy (circulate)*

Bronchoscopy (circulate)*

Lung/ Wedge Resection (circulate)*

Circulate - Endoscopy

Bronchoscopy (circulate)*

Cystoscopy (circulate)*

Gastroscopy (circulate)*

Colonoscopy (circulate)*

Circulate - Cardiovascular

A-V Shunts (circulate)*

Aortic Aneurysm, Abdominal (circulate)*

Aorto-Femoral Bypass (circulate)*

Graft Insertion (circulate)/*

Cardiac Valve Replacement (circulate)*

Coronary Artery Bypass Graft- on Pump (circulate)*

Endarterectomy- Carotid/ Femoral (circulate)*

Femoral- Popliteal Bypass (circulate)*

External Temporary Pacemaker (circulate)*

Internal Pacemaker Insertion (circulate)*

Intra-Aortic Balloon Pump Catheter (circulate)*

Patent Ductus Repair (circulate)*

Pericardial Windows (circulate)*

Portasystemic Shunt (circulate)*

Repair of Septal Defects (circulate)*

Thrombectomy (circulate)*

Vena Cava Ligation (circulate)*

Circulate - Transplants

Pancreas (circulate)*

Heart (circulate)*

Lung (circulate)*

Liver (circulate)*

Kidney (circulate)*

Eye (circulate)*

Scrub - Experience with Ages

Experience with the Following Ages

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 Surgery

Abdominal Perineal Resection (scrub)*

Adrenalectomy (scrub)*

Bariatrics (scrub)*

Bowel Resection (scrub)*

Cholecystectomy (scrub)*

Colostomy/ Ileostomy (scrub)*

Gastrectomy (scrub)*

Hemicolectomy (scrub)*

Hepatic Resection (scrub)*

Herniorrhaphy- Femoral/ Inguinal (scrub)*

Hiatal Herniorrhaphy- Transabdominal (scrub)*

Pancreatectomy (scrub)*

Organ Procurement (scrub)*

Radical Mastectomy (scrub)*

Saphenous Vein Ligation and Stripping (scrub)*

Splenectomy (scrub)*

Thyroidectomy (scrub)*

Tracheostomy (scrub)*

Whipple Procedure (scrub)*

Scrub - Laparoscopic Procedures

Cholecystectomy (scrub)*

Appendectomy (scrub)*

Hernia Repair (scrub)*

Colon Resection (scrub)*

Scrub - Gynecology

Caesarean Section (scrub)*

Dilation and Curettage (scrub)*

Hysterectomy- Vaginal (scrub)*

Hysterectomy- Abdominal (scrub)*

Laser Surgery (scrub)*

Radium Insertion (scrub)*

Salpingo- Oopherectomy (scrub)*

Shirodkar Procedure (scrub)*

Termination of Pregnancy (scrub)*

Tubal Ligation (scrub)*

Vaginectomy (scrub)*

Vaginal Reconstruction (scrub)*

Scrub - G.U. and CYSTO

Circumcision (scrub)*

Cystoscopy/ Cystostomy (scrub)*

Cystectomy (scrub)*

Hypospadius Repair (scrub)*

Ileal Loop (scrub)*

Lithotripsy (scrub)*

Nephrectomy (scrub)*

Orchiectomy (scrub)*

Penile Implant (scrub)*

Prostatectomy (scrub)*

Ureterolithotomy (scrub)*

T.U.R.P./T.U.R.B (scrub)*

Vasectomy (scrub)*

Scrub - Orthopedic

Amputation- Leg/ Arm (scrub)*

Application of Halo Traction (scrub)*

Arthroscopy/ Arthrotomy (scrub)*

Closed Pinning & Reduction of Extremities (scrub)*

External Compression Devices (scrub)*

Insertion of Finger Prosthesis (scrub)*

Tooth Extractions (scrub)*

Total Hip Replacement (scrub)*

Total Shoulder Replacement (scrub)*

Total Knee Replacement (scrub)*

Spinal Fusion- Harrington Rods (scrub)*

Spica Cast Application (scrub)*

O.R.I.F.- Shoulder, Hip, Humerus, etc. (scrub)*

Repair of Dislocation (scrub)*

Patellectomy (scrub)*

Tendon Implants & Reanastomosis (scrub)*

Scrub - Neurosurgery

Anterior Cervical Fusion (scrub)*

Burrholes for Subdural Hematoma (scrub)*

Craniotomy (scrub)*

Laminectomy (scrub)*

Meningocele Repair (scrub)*

Shunt Procedures- VP/ VA (scrub)*

Scrub - Plastics

Abdominoplasty/ Abdominal Lipectomy (scrub)*

Augmentation Mammoplasty (scrub)*

Cleft Lip/ Palate Repair (scrub)*

Dermabrasion (scrub)*

Digital Flexor Tendon Repair (scrub)*

Liposuction (scrub)*

Myelomeningocele Repair (scrub)*

Otoplasty (scrub)*

Rhinoplasty (scrub)*

Reduction of Facial Fracture (scrub)*

Scar Revision (scrub)*

Skin Meshing (scrub)*

Split Thickness Skin Grafting (scrub)*

Scrub - Eye

Excision of Chalazion (scrub)*

Canthotomy (scrub)*

Correction of Ectropian/ Entropian (scrub)*

Corneal Transplant (scrub)*

Enucleation (scrub)*

I.O.I Implants (scrub)*

Lacrimal Duct Probing (scrub)*

Refractive Keratoplasty (scrub)*

Repair of Retinal Detachment (scrub)*

Vitrectomy (scrub)*

Scrub - Ear, Nose, and Throat

Caldwell-Luc (scrub)*

Ethymoidectomy (scrub)*

Frontal Flap Sinus Procedure (scrub)*

Laryngectomy (scrub)*

Open Reduction Facial Fractures (scrub)*

Radical Neck (scrub)*

Tonsillectomy & Adenoidectomy (scrub)*

Myringotomy (scrub)*

Mastoidectomy (scrub)*

Tympanoplasty (scrub)*

Stapedectomy (scrub)*

Nasal Polypectomy (scrub)*

Laryngoscopy (scrub)*

Scrub - Thoracic

Chest Tube Set-Up (scrub)*

Hiatal Hernia (scrub)*

Pneumonectomy/ Lobectomy (scrub)*

Sternal Splitting (scrub)*

Thoracotomy (scrub)*

Bronchoscopy (scrub)*

Lung/ Wedge Resection (scrub)*

Scrub - Endoscopy

Bronchoscopy (scrub)*

Cystoscopy (scrub)*

Gastroscopy (scrub)*

Colonoscopy (scrub)*

Upper Endoscopy (scrub)*

Scrub - Cardiovascular

A-V Shunts (scrub)*

Aortic Aneurysm, Abdominal (AAA) (scrub)*

Aorto-Femoral Bypass (scrub)*

Graft Insertion (scrub)*

Cardiac Valve Replacement (scrub)*

Coronary Artery Bypass Graft-on Pump (scrub)*

Endarterectomy- Carotid/ Femoral (scrub)*

Femoral- Popliteal Bypass (scrub)*

External Temporary Pacemaker (scrub)*

Internal Pacemaker Insertion (scrub)*

Intra-Aortic Balloon Pump Catheter (IABP) (scrub)*

Patent Ductus Repair (scrub)*

Portasystemic Shunt (scrub)*

Pericardial Windows (scrub)*

Repair of Septal Defects (scrub)*

Thrombectomy (scrub)*

Vena Cava Ligation (scrub)*

Scrub - Transplants

Pancreas (scrub)*

Heart (scrub)*

Lung (scrub)*

Liver (scrub)*

Kidney (scrub)*

Eye (scrub)*

Equipment

Electrocautery*

Robotics*

Fracture Tables*

Video Systems*

CUSA*

Cell Saver*

PACS Diagnostics*

Drills*

Stapling Devices*

Ventilators*

Cardiac Monitors*

Crash Carts*

Defibrillators*

Sterilization of Equipment

Log*

Biological Indicators*

Autoclave Operation*

High Level*

STERIS*

Steam*

Gas*

Flash*

Miscellaneous

Crash Cart*

Universal Protocol*

Patient Identification*

Hand-off Communication*

Standard Precautions*

Isolation Precautions*

Pediatric Respiratory/ Cardiac Arrest*

Adult Respiratory/ Cardiac Arrest*

Automated Med Dispensing Systems*

Electronic Documentation*

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.

By completing this Skills Checklist, you agree to receive calls, AI-generated calls, text messages, or emails from and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at Privacy Policy.