PET Scan Technician Skills Checklist

Requested by:

Requested by email:

Today's Date: * +

First Name: *

Last Name: *

Mobile Phone Number: *

Email Address: *

Confirm email: *

GENERAL SKILLS EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

HIPAA Regulations	123
National Patient Safety Goals	123
Awareness of HCAHPS scores	123
Electronic Medical Record	123
Accurate Patient Identification	123
Proper body mechanics	123
Technique to preserve respect and dignity for patients	123
Introduction of self prior to providing care	123

PATIENT CARE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Fall risk assessment/prevention	123
Venipunctures/IV insertion	123
Vital Signs	123
Appropriate contrast Media	123
Anaphylactic reactions	123
Side effects	123
Shielding	123
Radiation safety	123
Obtain consent	123
ALARA (as low as reasonably achievable) standards	123

PROCEDURES:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Head	123
Neck	123
Spine	123
Heart	123
Coronary artery angiography	123
Vena Cava	123
Calcium scoring	123
Lungs	123
PE study	123
Lung nodule study	123
Abdomen	123
Kidneys	123
Appendicitis	123
Bladder	123
Liver	123
Pancreas	123
Spleen	123
Pelvis	123
Urology	123
Musculoskeletal	123
Arms	123
Hands	123
Feet	123
Legs	123
Shoulder	123
SI Joints	123
Hips	123
Trauma	123
Aspirations	123
Biopsies	123
Drainages	123
Image archiving	123
Quality Control Equipment	123
Wipe Test	123
Dose Calibrator management	123
Generator management	123

INFECTION CONTROL:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Hand hygiene	123
Precautions associated with PPE (transmission, contact, airborne, droplet)	123
Universal Precautions	123
Negative-pressure room	123
Prevention and protocols for HAIs (CAUTI, CLABSI, VAP)	123
Prevention and protocols for MRSA, C.DIFF, Sepsis, etc.	123

WORK SETTING EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Acute care hospital	123
Long term care	123
Rehabilitation center	123
Home health/private duty	123
Hospice	123

AGE-SPECIFIC EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Newborn / neonate (birth-30 days)	123
Infant (31 days-1 year)	123
Toddler (ages 2-3 years)	123
Preschool (ages 4-5 years)	123
School age (ages 6-12 years)	123
Adolescent (ages 13-21 years)	123
Young adult (ages 22-39 years)	123
Adult (ages 40-64 years)	123
Older adult (ages 65-79 years)	123
Elderly (ages 80+ years)	123

Attestation

ATTESTATION: *

I certify that the information provide above accurately reflects my experience in each of the clinical areas identified within the past three years.

If you agree with the Attestation above, please electronically sign your name. *