Radiation Therapist Skills Checklist

Requested by:

Requested by email:

Today's Date: * +

First Name: *

Last Name: *

Mobile Phone Number: *

Email Address: *

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PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS:

Proficiency

I have never done the stated task.
I have performed the task/skill infrequently; I require more experience/practice to feel comfortable and proficient.
I have performed the task/skill several times and feel moderately comfortable functioning independently but would require a resource person nearby.
I have performed the task/skill frequently and would feel very comfortable and proficient performing it without supervision or practice.

Frequency

RADIATION THERAPY *

	SKILL		FREQUENCY
Linear Accelerator
Linear Accelerator with Electrons
Superficial Radiation Treatment
Simulation of Treatment Sites
Treatment Planning
Cobalt 60 Therapy
Hyperthermia Treatment
Strontium 90 Therapy
Dosimetry
Calculations
Radiation Precautions

TREATMENT TO PATIENTS WITH *

GENERAL SKILLS *

NATIONAL PATIENT SAFETY GOALS *

	SKILL		FREQUENCY
Accurate Patient Identification
Effective Communication
Pain Assessment
Pain Management
Infection Control
Universal Precautions
Minimize Risk of Falls
Prevention of Pressure Ulcers

AUTOMATED MEDICATION DISPENSING SYSTEMS *

ELECTRONIC DOCUMENTATION *

AGE SPECIFIC COMPETENCIES *

	SKILL		FREQUENCY
Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler (1-3 years)
Preschooler (3-5 years)
School age children (5-12 years)
Adolescents (12-18 years)
Young adults (18-39 years)
Middle adults (39-64 years)
Older adults (64-79 years)
Elderly adults (80+ years)

Attestation

ATTESTATION: *

I certify that the information provided 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. *