Loading

Phlebotomy General

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)*

Patient Identification

Inpatient Identification*

Infants and Young Children Identification*

Emergency department Identification*

Ambulatory Patient Identification*

Equipment

Alcohol Swabs*

Arterial Blood Gas Kit*

Cotton Swabs*

Occult Blood Packets*

Heel Warmers*

Infant Restraints*

Laboratory Requisitions*

Pin Worm Kits*

Vacutainer Holders*

VacutainerT*

Blood Culture Bottles*

Blood Culture Preparation kits*

Centrifuge*

24 Hour Urine Containers*

Capillary Blood Kits*

Bacteria Media*

Drug Screen kit*

Ova Parasite Containers*

Legal Blood Draw Kits*

Paternity Blood Draw Kits*

RSV Kits*

Glucola*

Red Top Tubes (plain)*

Light Blue Top Tubes (Coag, Sodium Citrate)*

Serum Separator (SST, tiger top*

Green Top(Heparin, Lithium, NA+, ammonium*

Purple Top (EDTA)*

Gray Top (NA+ Fluoride and K+ oxalate)*

Brown Top (Lead)*

Butterfly Needles*

Other - Rate*

General

Venipuncture Sites*

Warming the Puncture site*

Tourniquet Application & Removal*

Decontamination of the Puncture Site*

Blood-Borne Pathogens Exposure Control Plan*

Tuberculosis Exposure Control Plan*

PPE (Personal protective equipment)*

Disposal of Contaminated items*

Bio-hazard Waste Containers*

Post Venipuncture Site Care*

Order of Tube Collection*

Skin Puncture Sites*

Patient Positioning*

Electronic Documentation*

Complications / Troubleshooting

Fainting*

Hematoma*

Failure to Draw Blood*

Petechiae*

Excessive Bleeding*

Mastectomy*

Edema*

Collapsed Veins*

Hemolysis*

Burned or Scarred Areas*

Techniques

ABG Draws*

Venipuncture*

Heel Stick*

Finger Stick*

Microcapillary Skin Puncture*

Other - Rate*

Transport

Chilled Specimens*

Warmed Specimens*

Protection of Specimen from light*

Microbiological Specimens*

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.