X-Ray Technician/ Radiography Technician Skills Checklist

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Today's Date: * +

First Name: *

Last Name: *

Mobile Phone Number: *

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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

RADIOLOGY:

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 *

Abdomen	123
Arthrograms	123
Bone Density	123
Chest	123
ER Exams	123
GI Series	123
Hip	123
Hysterosalpingogram	123
OR Exams	123
PACS System	123
Portable Exams	123
Renal Tomography	123
Soft Tissue Studies	123
Trauma Exams	123
Urethrography	123
Pelvic/Obliques/Judet Views	123
Pelvic Sacrum/Coccyx	123
Pelvic SI Joints	123
Upper/Lower	123
Facial	123
Mandible	123
Orbits	123
Sinus Series	123
Cervical Spine	123
Cervical Spine-Obls/Flexion/Extension	123
Lumbar spine	123
Lumbar Spine-Obls/Flexion/Extension	123
Thoracic Spine	123
Thoracic Spine-Swimmer's View	123

FLUOROSCOPY:

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 *

Angiogram	123
Arteriogram	123
Barium Enema	123
Bronchogram	123
ERCP	123
Esophagram	123
Gallbladder	123
Myelogram	123
Sialogram	123
Small Bowel Follow Through	123
Small Bowel Series	123
Tomogram	123
T-Tube Cholangiogram	123
Upper GI Series-Air Contrast	123
Upper GI Series-Single Contrast	123
Venograms	123
Voiding Cystogram	123
Modified Barium Swallow/Protocol Swallow	123
Swallow Studies with Videotaping	123
Mobile C-Arm Bronchoscopy with Fluoro Guidance	123
IVP with Tomograms	123

OR CASES:

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 *

Cystography	123
Extremity Studies	123
Hip Studies	123
Operative Cholangiography	123
Retrograde Urography	123
Spine Work	123
Sterile Procedures in OR	123

MYELOGRAMS:

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 *

Cervical Spine	123
Lumbar Spine	123
Thoracic Spine	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

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. *