Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Processing | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Single instruments |
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Endoscopes |
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Repair |
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Sets/ Trays |
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Care of instruments |
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Other (list): |
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Decontamination | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Manual cleaning |
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Washer sterilizer |
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Soiled linen |
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Disinfectants |
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Sharps |
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Disposable items |
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Cleaning equipment |
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Detergents |
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Dress code |
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Other (list): |
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Steam Sterilization | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Chart recording |
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Biological monitoring |
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Time |
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Testing/ Monitoring |
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Other (list): |
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Tests | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Test control |
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Recording |
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Other (list): |
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Assembly andPreparation | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Wrapping materials |
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Autoclave tape |
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Dust covers |
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Proper towel/ linen folding |
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Proper labeling |
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Expiration dates |
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Packing for steam |
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Heat sealing |
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Instrument count sheets |
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Placing instruments on trays |
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Other (list): |
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Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Infant (Birth - 1 year) |
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Preschooler (ages 2-5 years) |
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Childhood (ages 6-12 years) |
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Adolescents (ages 13-21 years) |
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Young Adults (ages 22-39 years) |
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Adults (ages 40-64 years) |
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Older Adults (ages 65-79 years) |
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Elderly (ages 80+ years) |
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