CYNET_SYSTEMS_MAIN_LOGO.gif   Medical Laboratory 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) Medical Laboratory 1 2 3 4  
Blood bank  
Chem  
Hemo  
Micro  
Serol  
Patient positioning  
Fingerstick  
Venipuncture  
Warming the puncture site  
Tourniquet application & removal  
Decontamination of the puncture site  
Tuberculosis exposure control plan  
Post venipuncture site care  
Order of tube collection  
Rating Stars (Click) Equipment 1 2 3 4  
Arterial blood gas kits  
Occult blood packets  
Heel warmers  
Pin worm kits  
Serum separators  
Blood culture preparation kits  
Centrifuge  
Capillary blood kits  
Bacteria media  
Drug screen kits  
Ova parasite containers  
Legal blood draw kits  
Paternity blood draw kits  
RSV kits  
Rating Stars (Click) Chemistry 1 2 3 4  
Acetone analysis  
Atomic absorption  
B12/folates  
CSF protein  
Drug monitoring  
Electrolytes  
Electrophoresis  
Gas chromatography  
Hepatitis  
Hormone testing  
Immunoelectrophoresis  
Include blood gas  
Main chemistry unit  
Osmolality  
Stool analysis (fecal fats)  
Thin layer chromatography  
Thyroid testing  
Tumor markers  
Rating Stars (Click) RIA 1 2 3 4  
Background counts  
Counters  
Curves/regressions  
Data reduction  
Instrumentation/gamma  
Radiation safety techniques  
Scintillation counter  
Rating Stars (Click) Blood Bank 1 2 3 4  
Antibody identification  
Antibody titer  
Blood irradiation  
Component preparation  
Rating Stars (Click) Coombs test: 1 2 3 4  
Direct  
Indirect  
Cross match  
Donor unit collections  
Emergency release  
Freezing blood  
Immediate spin cross match  
Patient identification  
Plasmapheresis  
Plateletpheresis  
Procedures  
Rhogam  
Antigen typing  
Type, RH  
Rating Stars (Click) Microbiology/Virology 1 2 3 4  
Concentration techniques  
Identification  
Acid fast stain (fluorescent)  
Acid fast stain (kinyoun)  
Anaerobic culture  
Anaerobic identification  
Blood culture  
C. difficile assay  
Cell culture technique (viral)  
Chlamydia culture  
Chlamydia smear  
Culture plating  
Darkfield  
Gram stain  
India ink  
KOH prep  
Malarial examination  
Myobacteria culture  
Occult blood  
Organism identification  
Ova & parasite concentration  
Trichcone  
Wet mount  
Rating Stars (Click) Sensitives: 1 2 3 4  
K.B.  
M.I.C.  
Virus isolation  
Wet mount-motility  
Rating Stars (Click) Urinalysis 1 2 3 4  
Automated instrumentation:  
Large volume automation equipment  
Small volume automation equipment  
Crystal identification  
Macroscopic U.A  
Microscopic U.A  
Semen analysis  
Rating Stars (Click) Hematology 1 2 3 4  
Bleeding time  
Body fluid count  
CBC  
D-dimer  
Differential  
Eosinophil count  
Factor assays  
Fetal hemoglobin  
Fibrin split products/FDP  
Fibrinogen  
Lee-White clotting time  
Platelet aggregation  
Platelet count  
PT & PTT  
Reticulocyte count  
Sedimentation rate  
Special stains (PAS, peroxidase, leukocyte alkaline phosphatase)  
Sickle cell prep  
Thrombin time  
Rating Stars (Click) Serology / Immunology 1 2 3 4  
ANA  
ASO titer  
C3, C4, total complement  
Cold agglutinins  
C-reactive protein  
ELISA testing  
Febrile agglutinations  
Fluorescent testing  
FTA-ABS  
Hemagglutination inhibition  
LE cell prep  
Monospot  
Pregnancy testing  
Radial immuno diffusion  
Rheumatoid factor  
RPR  
Rubella serology  
TORCH studies  
Rating Stars (Click) National Patient Safety Goals 1 2 3 4  
Accurate patient identification  
Labeling  
Effective communication  
Infection control  
Quality control/quality assurance  
Assist with On-site procedure  
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)  
  Please list any Additional Skills:  
   
   
   
   
  Additional training  
   
   
   
   
  Additional training