Ultrasound Technologist (General) Skills Checklist

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Last Name: *

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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 *

Advanced directives	123
Vital Signs	123
Care of patients in restraints	123
Use of transfer/lifting devices	123
Care of patients in isolation	123
Knowledge of "Do Not Use Abbreviations"	123
Charge/Supervisor experience	123
Knowledge of current Joint Commission National Patient Safety Goals	123
Knowledge/familiarity with HCAHPS scores	123
IV Pumps: Alaris	123
IV Pumps: Alibaba	123
IV Pumps: Bard	123
IV Pumps: Baxter	123
IV Pumps: Braun	123
IV Pumps: Other	123

ULTRASOUND:

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 *

General Ultrasound	123
Aorta	123
Appendix	123
Biliary Tract	123
Gall Bladder	123
Intra Operative Ultrasound	123
Liver	123
Lung Biopsy	123
Pancreas	123
Paracentesis, thoracentesis	123
Renal/Cyst Aspiration	123
Pelvic male	123
Ultrasound Guided Biopsy	123
Adnexa	123
Endometrial	123
Ovaries	123
Transvaginal	123
Uterus	123
Amniotic fluid (normal and abnormal)	123
Crown rump length	123
Fetal demise	123
Left Ventricular outflow tract	123
Right Ventricular outflow tract	123
Multiple pregnancy	123
Lower uterine segment	123
Nuchal Translucency	123
Placenta Previa	123
High Risk OB	123

ECHO:

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 *

3-D Echo	123
2-D	123
M-Mode	123
Pulsed Wave Doppler	123
Continuous Wave Doppler	123
Color Doppler	123
Pedoff probe in apical	123
Pedoff probe in suprasternal	123
Pedoff probe in parasternal right	123
4 chamber view	123
2 chamber view	123
Subcostal view	123
Suprasternal view	123
Pulmonary Veins	123
Hepatic Veins	123
Continuity Equation	123
PISA	123
Diastolic Dysfunction Study	123
Simpson's Rule	123
Cardiac Anatomy	123
LV Strain/LV Volume	123
Treadmill Stress Echo	123
Pharmacological Stress Echo	123
Transesophageal Echo	123
Bubble Study	123
Contrast Study	123
Pediatric post-surgical scans ( Arterial switch, Blalock-Taussig)	123
Fontan, Glenn, Konno, Norwood, Rastelli Sano, Sennig)	123
Cardiac Anomalies - Aortic arch abnormailities, Coronary arter amonlies	123
Tetralogy of Fallot	123
Transposition of the Great Vessel	123
Saline Infused Sonohysterography (SIS)	123
Amniocentesis	123
Holter Monitors	123
Carotid Ultrasound	123
Venous (arm/leg)	123
Arterial (arm/leg)	123
Hysterosonography	123
Biopsy	123
Transvaginal	123
Testicular	123
Gallbladder	123
Renal	123
Abdominal/Pelvis	123
Renal	123
OB/GYN exams	123
Drainage	123

VASCULAR:

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 *

M-Mode	123
Color Flow	123
Real Time	123
Duplex	123
Flow Studies	123
Photoplethysmography	123
Strain Gauge and Pneumoplethysmography	123
Continuous Wave Doppler	123
Area of Percentage of Stenosis	123
Diameter for Percentage of Stenosis	123
Post Void Residual	123
Impedance Plethysmography (IPG), R/O DVT	123
Palmer Arch	123
Pulse Volume Recording	123
Segmental Pressures	123
Abdomen and Pelvis: Arterial - Aorta	123
Abdomen and Pelvis: Arterial/Venous - Superior Mesenteric	123
Abdomen and Pelvis: Arterial – Celiac	123
Arterial/Venous - Hepatic: Arterial/Venous - Iliacs	123
Arterial/Venous - Hepatic: Arterial/Venous Renal	123
Arterial/Venous - Hepatic: Arterial/Venous - Splenic	123
Arterial/Venous - Hepatic: Venous - Inferior Vena Cava	123
Arterial/Venous - Hepatic: Venous – Portal	123
Arterial Peripheral Vasculature: Upper Extremity	123
Arterial Peripheral Vasculature: Digital	123
Arterial Peripheral Vasculature: Dialysis Graft	123
Arterial Peripheral Vasculature: Lower Extremity	123
Arterial Peripheral Vasculature: Graft Patency	123
Venous Peripheral Vasculature: Upper Extremity	123
Venous Peripheral Vasculature: Lower Extremity	123
Venous Peripheral Vasculature: Vein Mapping	123
Venous Peripheral Vasculature: Reflux Testing (valve competence)	123
Venous Peripheral Vasculature: Color Doppler imaging	123
Venous Peripheral Vasculature: Cardiac Vasculature	123
Venous Peripheral Vasculature: Stress/pressure Testing:	123
Venous Peripheral Vasculature: Segmental Pressures	123
Venous Peripheral Vasculature: Volume Pulse recording	123
Venous Peripheral Vasculature: Pulse Cuff recording	123
Venous Peripheral Vasculature: Digital pressure	123
Venous Peripheral Vasculature: Reactive Hyperemia/Post exercise	123
Venous Peripheral Vasculature: Neck Vasculature	123
Venous Peripheral Vasculature: Carotid Arteries	123
Venous Peripheral Vasculature: Vertebral Arteries	123
Venous Peripheral Vasculature: Subclavian Arteries	123

TYPES OF EQUIPMENT:

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 *

GE	123
Philips	123
Siemens	123
Toshiba	123
PACS System	123
RIS-Cerner	123
Hitachi	123
HP	123
Picker	123

WORK SETTING:

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 *

Hospital Experience	123
Clinic Experience	123
Teaching/Educational Facility	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 to 30 days)	123
Infant (31 days to 12 months)	123
Toddler/Preschool (13 months to 5 years)	123
School Age Child/adolescent (6 years to 18 years)	123
Young Adults/Middle Adult (19 years to 64 years)	123
Older Adults/Elderly (65+ 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. *