Name:
Email:
LAST 4 OF SSN:
This checklist was electronically signed on (Today’s date)
This checklist is designed to guide our client facilities in assessing your proficiency in your nursing specialty. Please use the scale provided to indicate your level of experience and expertise in each of the areas listed below.
Skill Level Indicator:
★ = No Experience
★★ = Requires Training
★★★ = Capable with Supervision
★★★★ = Capable Independently
Free Standing Lab
Reference Lab
Specialty Lab
Histology Universal Precautions
Routine Processing Schedule
GI Processing Schedule
Microwave Processing
Frozen Section Processing
Bone Decal
Bone Marrow Processing & Decal
Follow Recommended Protocol for Sample
Processor Quality Control & Maintenance
Embedding Skin
Embedding Large Specimens
Embedding GI Specimens
Embedding on Edge
Embedding on End
Special Embedding Instructions
Removing Foreign Objects as Allowed by Protocol
Embedding Quality Control & Maintenance
Automated Microtome
Manual Microtome
Microtomy of Hard Tissue
Microtomy of Fatty Tissue
Microtomy of Frozen Sections
Microtome Quality Control & Maintenance
Manual
Automated
Purchased Antibodies
Antibody Aliquot
Multiple Chromogens
Protocols per Instrument
Protocols per Hand
Maintain Supply Inventory
IHC Stainers
Quality Control & Maintenance
Record Keeping/Maintenance
Automated H & E
Manual H & E
Connective Tissue
Fungal
Microorganism
Pigment/Mineral
Automated Special Stains
Manual Special Stains
Special Staining Quality Control
Thin Prep Processor
Sure Path
Focal Point Imaging
Cytospin
CoPath
Sakura Tissue Processor
Leika PELORIS
Ventana Tissue Processor
Thermo Scientific Processor
Pathos Processor
Cerner
Epic
Meditech
Sunquest
Digital Imaging
I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
