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Surgical Tech

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

Scrub Skills

General Surgery

Abdominal Perineal Resection*

Adrenalectomy*

Bowel Resection*

Cholecystectomy*

Colostomy/ Ileostomy*

Gastrectomy*

Hemicolectomy*

Hepatic Resection*

Herniorrhaphy-Femoral/ Inguinal*

Hiatal Herniorrhaphy- Transabdominal*

Pancreatectomy*

Organ Procurement*

Radical Mastectomy*

Saphenous Vein Ligation and Stripping*

Splenectomy*

Thyroidectomy*

Tracheostomy*

Whipple Procedure*

Laparoscopic Procedures

Hysterectomy*

Cholecystectomy*

Appendectomy*

Hernia Repair*

Colon Resection*

Gynecology

Caesarean Section*

Dilation & Curettage*

Hysterectomy- Vaginal*

Hysterectomy- Abdominal*

Laser Surgery*

Radium Insertion*

Salpingo- Oopherectomy*

Shirodkar Procedure*

Termination of Pregnancy*

Tubal Ligation*

Vaginectomy*

Vaginal Reconstruction*

G.U. and CYSTO

Circumcision*

Cystoscopy/ Cystostomy*

Cystectomy*

Hypospadius Repair*

Ileal Loop*

Lithotripsy*

Nephrectomy*

Orchiectomy*

Penile Implant*

Prostatectomy*

Ureterolithotomy*

T.U.R.P./T.U.R.B*

Vasectomy*

Orthopedic

Amputation- Leg/ Arm*

Application of Halo Traction*

Arthroscopy/ Arthrotomy*

Closed Pinning & Reduction of Extremities*

External Compression Devices*

Insertion of Finger Prosthesis*

Total Joint Replacement- Knee, Hip, Shoulder*

Spinal Fusion- Harrington Rods*

Spica Cast Application*

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

Repair of Dislocation*

Patellectomy*

Tendon Implants & Reanastomosis*

Neurosurgery

Anterior Cervical Fusion*

Burrholes for Subdural Hematoma*

Craniotomy*

Laminectomy*

Meningocele Repair*

Shunt Procedures- VP/ VA*

Plastics

Face Lift*

Skin Grafting*

Abdominoplasty/ Abdominal Lipectomy*

Augmentation Mammoplasty*

Cleft Lip/Palate Repair*

Dermabrasion*

Digital Flexor Tendon Repair*

Liposuction*

Myelomeningocele Repair*

Otoplasty*

Rhinoplasty*

Reduction of Facial Fracture*

Eye

Excision of Chalazion*

Canthotomy*

Correction of Ectropian/ Entropian*

Corneal Transplant*

Enucleation*

I.O.I. Implants*

Lacrimal Duct Probing*

Refractive Keratoplasty*

Repair of Retinal Detachment*

Vitrectomy*

Cataracts*

Ear, Nose, and Throat

Caldwell-Luc*

Ethymoidectomy*

Frontal Flap Sinus Procedure*

Laryngectomy*

Open Reduction Facial Fractures*

Radical Neck*

Tonsillectomy & Adenoidectomy*

Myringotomy*

Mastoidectomy*

Tympanoplasty*

Stapedectomy*

Nasal Polypectomy*

Laryngoscopy*

Thoracic

Chest Tube Set- Up*

Hiatal Hernia*

Pneumonectomy/ Lobectomy*

Sternal Splitting*

Thoracotomy*

Bronchoscopy*

Lung/Wedge Resection*

Endoscopy

Bronchoscopy*

Cystoscopy*

Gastroscopy*

Colonoscopy*

Cardiovascular

A-V Shunts*

Aortic Aneurysm, Abdominal*

Aorto-Femoral Bypass*

Graft Insertion*

Cardiac Valve Replacement*

Coronary Artery Bypass Graft-on Pump*

Endarterectomy-Carotid/Femoral*

Femoral-Popliteal Bypass*

External Temporary Pacemaker*

Internal Pacemaker Insertion*

Intra-Aortic Balloon Pump Catheter*

Patent Ductus Repair*

Pericardial Windows*

Repair of Septal Defects*

Thrombectomy*

Vein Harvesting*

Vena Cava Ligation*

Aortobifemoral Bypass*

Aortocaval Fistula Repair*

Arteriovenous Fistula Repair*

Atherectomy*

Carotid Endarterectomy*

Renal Artery Bypass Surgery*

Transplants

Pancreas*

Heart*

Lung*

Liver*

Kidney*

Eye*

Equipment

Robotics*

Fracture Tables*

Video Systems*

CUSA*

Cell Saver*

PACS Diagnostics*

Electrocautery*

Drills*

Saws*

Stapling Devices*

Cardiac Monitors*

Crash Carts*

Defibrillators*

Sterilization of Equipment

Log*

Biological Indicators*

Autoclave Operation*

High Level*

STERIS*

Steam*

Gas*

Flash*

Miscellaneous

Universal Protocol*

Crash Cart*

Patient Identification*

Hand-off Communication*

Standard Precautions*

Isolation Precautions*

Pediatric Respiratory/Cardiac Arrest*

Adult Respiratory/Cardiac Arrest*

Electronic Documentation*

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)*

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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