Sterile Processing Tech Skills Checklist "*" indicates required fields Name* First Last Email* Phone*Years Experience in Clinical Specialty:*Directions for Completing Skills Checklist The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate the level of experience/proficiency with each and, where applicable, the types of equipment and/or systems with which you are familiar. Use the following KEY as a guideline: A) Theory Only/No Experience - Didactic instruction only, no hands-on experience. B) Limited Experience - Knows procedure/has used equipment, but has done so infrequently or not within the last six months. C) Moderate Experience - Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed. D) Proficient/Competent - Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach.Sterile Processing Tech1. PROCESSING:*ABCDSingle InstrumentsWrapped SetsInstrument ContainersEndoscopesRepairs2. SAFETY PROCEDURES:*ABCDProtective AttireStandard PrecautionsSharps HandlingManaging Biohazardous Waste3. DECONTAMINATION:*ABCDUse of WashersWasher/DisinfectorsWasher/SterilizersDetergent Use and RefillsChemical Agents for DecontaminationUltrasonic CleanerEquipment (e.g. crash carts, IV pumps)STERILIZATION 4. Steam Autoclave:*ABCDGravity DisplacementPrevacuumFlash5. Sterility Assurance Tests:*ABCDBowie DickBiologicalChemical6. Steam Sterilization:*ABCDLoad DocumentationCart LoadingTesting Validation ProceduresTrouble Shooting7. Gas (ETOH):*ABCDLoad DocumentationLoading ProceduresTesting Validation ProceduresTrouble Shooting8. Sterrad:*ABCDLoad DocumentationLoading ProceduresTesting Validation ProceduresTrouble Shooting9. Steris:*ABCDLoad DocumentationTray LoadingTesting Validation ProceduresTrouble Shooting10. ASSEMBLY AND PREPARATION:*ABCDInstrument Set AssemblySelection of Appropriate Wrapping MaterialAssembly of Peel Pack ItemsPreparation of Hard Instrument ContainersWrapping ProcedureSelection of Sterilization TapesTowel/Linen FoldingLabeling StandardsPeel Pack/Heat SealingInstrument Count SheetsPhysician Preference CardsCase PickingSterile Storage Standards11. SPECIALTY EQUIPMENT PROCESSING:*ABCDGeneralCardiacEndoscopyLaparoscopicNeurologyOB/GYNOphthalmologyOrthopedicsPlasticsRoboticsUrology* The information I have given is true and accurate to the best of my knowledge. I hereby authorize Professional Nursing Service to release my Skills Checklist to Client facilities of PNS in relation to consideration of employment as a Traveler with those facilities.Date* MM slash DD slash YYYY
