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.

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

AGE OF PATIENTS CARED FOR Rating Stars (Click) 1 2 3 4  
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) 
GENERAL LABORATORY Rating Stars (Click) 1 2 3 4  
Centrifuge Operation and Maintenance 
Refractometer Operation and Maintenance 
Cytospin Operation and Maintenance 
Hood Operation and Maintenance 
Proper Storage of Specimens for Later Testing 
Departmental Record Completion 
Departmental Sample Preparation 
Referral Testing – Sample Requirements, Packaging, Reporting 
Patient and Sample Identification 
Collection of Samples 
Specimen Labeling 
General Venipuncture 
Heel Stick 
Finger Stick 
Whole Blood Bedside Glucose Testing 
Preparation of Peripheral Blood Smears 
Collection of Specimens for Microbiology 
Emergency Identification Procedure 
Specimen Collection for Drug Testing 
Handling of Biohazardous Materials/Waste 
Guidelines for Specimen Rejection/Acceptance 
Standard Precautions 
Isolation Precautions 
Electronic Documentation 
TESTING Rating Stars (Click) 1 2 3 4  
Daily Startup Procedure 
Run and Review Q.C. 
Follow Policy/Procedure Corrective Action for Out-of-Range Q.C. 
Perform CBC Testing 
Perform PT and APTT Testing 
Perform Urinalysis Dipstick Procedures 
Perform Urinalysis Microscopic Procedures 
Perform Confirmation Testing for Positive Results 
Kit Testing (RPR, H. Influenza, Monotest UPT, RSV, Strep A Screen, Rotavirus, etc.) 
Culture Routine, Collection, and Setup 
Culture Collection Procedure 
Set Up Culture According to Protocols 
Proper Planting Techniques 
Seek Assistance for Critical or Absurd Results 
Report Acceptable Results 
Save/Archive/File Patient Results Per Policy 
Perform Preventative Maintenance 
Ability to Troubleshoot Instruments per Policy 
CYTOLOGY SPECIFIC Rating Stars (Click) 1 2 3 4  
Assist with Collection of Bronchoscopy 
Assist with Fine Needle Aspiration 
Assist with Cyst Aspiration 
Assist with Buccal Smears 
Assist with Renal Biopsies 
Assist with Effusions 
Assist with Pleural Biopsies 
Assist with Cytogenetics Prep 
Logging and Accessioning of Specimens 
Fixation of Specimens 
Staining and Coverslipping 
Processing of Specimens by Centrifuge Method 
Processing by Cytocentrifuge Method 
Filing Slides, Requisitions, and Reports 
Carbowax Preparation 
Cresyl Violet Preparation 
3% Amphyl Preparation 
10% Bleach Preparation 
Scott’s Tap Water Preparation 
Saponin Preparation 
Centrifuge Operation and Maintenance 
Fume/Biological Hood Operation and Maintenance