CYNET_SYSTEMS_MAIN_LOGO.gif   HISTOLOGY TECHNICIAN SKILLS CHECKLIST
   NAME    
   LAST 4 OF SSN      
   DATE      
I hereby certify that ALL information I have provided to IMCS Group on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
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

  
       
Rating Stars (Click) HISTOLOGY 1 2 3 4  
Specimen Processing  
Concept of Fixation  
Assist with Frozen Sectioning  
QC Req and Documentation  
Collection of Tissue Specimen  
Bone Marrow Biopsy & Slides  
Filing of Slides & Blocks  
Embed Tissue (inc small Bxs)  
Running of Tissue Processor  
Cutting tissue blocks  
Microtome & Disposable Blades  
Principle of Hematoxylin & Eosin Stain  
Decalcify Bone & Hand Tissue  
Grossing Small Specimen  
Rating Stars (Click) SPECIAL STAIN TECHNIQUES 1 2 3 4  
Group I  
Group II  
Group III  
Group IV  
Group V (IHC)  
Storage Time of Wet Tissues  
Disposal of Wet Tissues  
Universal Histology Precautions  
Coverslipping  
Preparation of Stains/Reagents  
Proper Labeling of Reagents  
MOHS Sectioning  
QC & Maintenance  
Specimen Preservation  
Rating Stars (Click) CYTOLOGY 1 2 3 4  
GYN Prep & Staining  
Non-GYN Prep/Staining  
FNA Collections  
Thin Prep  
Rating Stars (Click) LAB INFORMATION SYSTEM 1 2 3 4  
Softlab  
Sunquest  
Cerner  
Meditech  
WinSURGE  
Rating Stars (Click) NATIONAL PATIENT SAFETY GOALS 1 2 3 4  
Accurate patient identification  
Labeling  
Effective communication  
Interpretation & communication of lab values  
Universal precautions  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1      
COMMUNITY ER      
RURAL ER      
Rating Stars (Click) AGE APPROPRIATE CARE 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)